Provider Demographics
NPI:1780895136
Name:EDWARDS, SHERRIE FENNELL (RD,LDN)
Entity type:Individual
Prefix:MRS
First Name:SHERRIE
Middle Name:FENNELL
Last Name:EDWARDS
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 1:1804 DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2320
Mailing Address - Country:US
Mailing Address - Phone:919-739-5081
Mailing Address - Fax:
Practice Address - Street 1:1500 LANELY AVE.
Practice Address - Street 2:SEYMOUR JOHNSON AFB
Practice Address - City:GOLSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534
Practice Address - Country:US
Practice Address - Phone:919-722-0407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC714599133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic