Healthcare Provider Details

I. General information

NPI: 1659496271
Provider Name (Legal Business Name): ELIZABETH EDWARDS SHEEKS RD, MS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 GRAYSTONE PL SE
CONOVER NC
28613-8200
US

IV. Provider business mailing address

107 BUCKINGHAM PL
STATESVILLE NC
28625-4615
US

V. Phone/Fax

Practice location:
  • Phone: 828-328-1118
  • Fax: 828-328-1119
Mailing address:
  • Phone: 704-450-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberL000958
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: