Healthcare Provider Details

I. General information

NPI: 1306065966
Provider Name (Legal Business Name): SHERRI L MUNRO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

66A WINTER ST
NORWOOD MA
02062-3333
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-4545
  • Fax:
Mailing address:
  • Phone: 781-255-7417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number197
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: