Provider Demographics
NPI:1740648567
Name:SYLVESTER, HEATHER (RD, LDN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5218 SHANNAMARA DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-0652
Mailing Address - Country:US
Mailing Address - Phone:856-417-4226
Mailing Address - Fax:
Practice Address - Street 1:5218 SHANNAMARA DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-0652
Practice Address - Country:US
Practice Address - Phone:856-417-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004798133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered