Healthcare Provider Details

I. General information

NPI: 1467880864
Provider Name (Legal Business Name): KATIE SHERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE FREDRICKS

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4923 OGLETOWN STANTON RD SUITE 200
NEWARK DE
19713-2081
US

IV. Provider business mailing address

4923 OGLETOWN STANTON RD SUITE 200
NEWARK DE
19713-2081
US

V. Phone/Fax

Practice location:
  • Phone: 302-225-0451
  • Fax: 302-225-0472
Mailing address:
  • Phone: 302-225-0451
  • Fax: 302-225-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN0000342
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: