Healthcare Provider Details

I. General information

NPI: 1053540377
Provider Name (Legal Business Name): SHARON LEIGH LEWIS-HACKLER MS, RD, LDN, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E ARLINGTON BLVD
GREENVILLE NC
27858-5870
US

IV. Provider business mailing address

2609 WEST ARLINGTON BLVD, SUITE 106
GREENVILLE NC
27834-3796
US

V. Phone/Fax

Practice location:
  • Phone: 252-364-2806
  • Fax: 252-364-2863
Mailing address:
  • Phone: 252-689-6303
  • Fax: 252-689-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number9
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL002396
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: