MEDICARE: SHERYL DIANE LOZICKI RD, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	711781	MI

General Provider Information

NPI Number	:	1861355760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERYL DIANE LOZICKI RD, MBA

Provider Business Mailing Address
First Line	:	575 HONEY CREEK AVE NE
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-9780
Country	:	US
Telephone Number	:	616-443-1501
Fax Number	:

Provider Business Practice Location Address
First Line	:	575 HONEY CREEK AVE NE
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-9780
Country	:	US
Telephone Number	:	616-443-1501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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