Healthcare Provider Details

I. General information

NPI: 1851212641
Provider Name (Legal Business Name): CHERYL HARRIS LD, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 TEMPLE DR
WINTER PARK FL
32789-1663
US

IV. Provider business mailing address

1800 TEMPLE DR
WINTER PARK FL
32789-1663
US

V. Phone/Fax

Practice location:
  • Phone: 917-887-1080
  • Fax:
Mailing address:
  • Phone: 917-887-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND15122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: