Healthcare Provider Details

I. General information

NPI: 1235097551
Provider Name (Legal Business Name): CHERYL GRAY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 COASTAL DR
BOCA RATON FL
33487-4116
US

IV. Provider business mailing address

5501 COASTAL DR
BOCA RATON FL
33487-4116
US

V. Phone/Fax

Practice location:
  • Phone: 303-875-8658
  • Fax:
Mailing address:
  • Phone: 303-875-8658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND13255
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberND13255
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberND13255
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: