Healthcare Provider Details

I. General information

NPI: 1376834705
Provider Name (Legal Business Name): SHERYL BEAUREGARD MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAM SNEAD DR
GREENSBORO NC
27410-6087
US

IV. Provider business mailing address

5912 FIREWOOD TRL
GREENSBORO NC
27410-9269
US

V. Phone/Fax

Practice location:
  • Phone: 336-202-2356
  • Fax: 336-299-1784
Mailing address:
  • Phone: 336-202-2356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL003129
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: