Healthcare Provider Details

I. General information

NPI: 1467786855
Provider Name (Legal Business Name): SHARON MEYER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 STAR BATT DR SUITE 200
ROCHESTER HILLS MI
48309-3712
US

IV. Provider business mailing address

1901 STAR BATT DR SUITE 200
ROCHESTER HILLS MI
48309-3712
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-5690
  • Fax: 248-844-5691
Mailing address:
  • Phone: 248-844-5690
  • Fax: 248-844-5691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number414938
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: