Provider Demographics
NPI:1376834705
Name:BEAUREGARD, SHERYL (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:BEAUREGARD
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 FIREWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9269
Mailing Address - Country:US
Mailing Address - Phone:336-202-2356
Mailing Address - Fax:
Practice Address - Street 1:1 SAM SNEAD DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-6087
Practice Address - Country:US
Practice Address - Phone:336-202-2356
Practice Address - Fax:336-299-1784
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003129133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered