Healthcare Provider Details

I. General information

NPI: 1669998456
Provider Name (Legal Business Name): SHERRY PATRICIA ROBERTS RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERRY PATRICIA VANCE RD,CDE

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 BROAD ST STE 14281
BOSTON MA
02109-4301
US

IV. Provider business mailing address

234 CROOKED CREEK PKWY
DURHAM NC
27713-8505
US

V. Phone/Fax

Practice location:
  • Phone: 888-404-4813
  • Fax: 888-675-4061
Mailing address:
  • Phone: 919-385-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number875729
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number074.0134640
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-2673
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND13877
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN-0011277
License Number StateDE
# 6
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3174
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberOLYMPIA
License Number StateAL
# 8
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI2064
License Number StateME
# 9
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2020001221
License Number StateMO
# 10
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL005047
License Number StateNC
# 11
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number129973
License Number StateIA
# 12
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number14195813-4901
License Number StateUT
# 13
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3923
License Number StateLA
# 14
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1962
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: