Healthcare Provider Details

I. General information

NPI: 1417141557
Provider Name (Legal Business Name): SHARON EVETTE HAWKS M.S, RD, LDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 ANNAPOLIS RD. STE. 104
GLENN DALE MD
20769
US

IV. Provider business mailing address

12150 ANNAPOLIS RD STE 104
GLENN DALE MD
20769-9183
US

V. Phone/Fax

Practice location:
  • Phone: 301-805-8292
  • Fax: 301-352-0405
Mailing address:
  • Phone: 301-805-8292
  • Fax: 301-352-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberD01715
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD01715
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberD01715
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberD01715
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: