Provider Demographics
NPI:1932230729
Name:MEEK, SHERRYL GAGELIN (RD)
Entity Type:Individual
Prefix:
First Name:SHERRYL
Middle Name:GAGELIN
Last Name:MEEK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 SUNDANCE CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1448
Mailing Address - Country:US
Mailing Address - Phone:907-563-8296
Mailing Address - Fax:
Practice Address - Street 1:3841 PIPER ST.
Practice Address - Street 2:STE. T4-054
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4673
Practice Address - Country:US
Practice Address - Phone:907-562-6228
Practice Address - Fax:907-562-6868
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK33133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK902280OtherBUSINESS LICENCE
AK33OtherPROFESSIONAL LICENSE
AKDT72372Medicaid