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General NPI Number Information
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NPI Number | 1649079914
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Entity Type | Individual
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Provider Name | SHERRY MOORE
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Gender | Female
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 3749 RIVER RD
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City | LUMBERVILLE
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State | PA
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Zip | 18933-9715
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Country | US
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Telephone | 267-218-1512
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Fax | 267-218-1512
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Provider Business Mailing Address
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Address Line | 3749 RIVER RD
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City | LUMBERVILLE
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State | PA
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Zip | 18933-9715
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Country | US
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Telephone | 267-218-1512
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | DN003213
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 133VN1101X
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Taxonomy Name | Gerontological Nutrition Registered Dietitian
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License Number | DN003213
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number | DN003213
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License Number State | PA
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