Healthcare Provider Details

I. General information

NPI: 1538245576
Provider Name (Legal Business Name): SHERRY P. COLLIER R.D., LD/N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 WILLOUGHBY BLVD.
STUART FL
34997
US

IV. Provider business mailing address

184 BAYBERRY PL
JUPITER FL
33458-7703
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-0304
  • Fax:
Mailing address:
  • Phone: 561-801-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND 4849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: