Provider Demographics
NPI:1760069363
Name:EDMONDS, SHARVETTE (MS, RDN)
Entity Type:Individual
Prefix:
First Name:SHARVETTE
Middle Name:
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:DIETITIAN
Other - Middle Name:
Other - Last Name:SHAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RDN
Mailing Address - Street 1:4533 MACARTHUR BLVD STE A5217
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2059
Mailing Address - Country:US
Mailing Address - Phone:949-409-1508
Mailing Address - Fax:949-955-2066
Practice Address - Street 1:4533 MACARTHUR BLVD STE A5217
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2059
Practice Address - Country:US
Practice Address - Phone:949-409-1508
Practice Address - Fax:949-955-2066
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA927230133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered