Provider Demographics
NPI:1912064684
Name:DAVIS, CHERYL (RD, CD, CNSD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RD, CD, CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18134 BRITTANY DR SW
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3810
Mailing Address - Country:US
Mailing Address - Phone:206-469-2712
Mailing Address - Fax:206-987-5087
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:MS W3726
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-469-2712
Practice Address - Fax:206-987-5087
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001906133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered