Provider Demographics
NPI:1710296413
Name:RILEA, CHERYL (MS, RD, LD)
Entity Type:Individual
Prefix:PROF
First Name:CHERYL
Middle Name:
Last Name:RILEA
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15191 SE 103RD AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-4602
Mailing Address - Country:US
Mailing Address - Phone:352-459-8121
Mailing Address - Fax:352-288-0416
Practice Address - Street 1:801 HIGHWAY 466
Practice Address - Street 2:STE B-101
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-459-8121
Practice Address - Fax:352-288-0416
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 612133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered