=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669998456
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERRY PATRICIA ROBERTS RD, CDE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2017
-----------------------------------------------------
Last Update Date | 10/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 56 BROAD ST STE 14281
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02109-4301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-404-4813
-----------------------------------------------------
Fax | 888-675-4061
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 234 CROOKED CREEK PKWY
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27713-8505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-385-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 875729
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 074.0134640
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | D-2673
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | ND13877
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | DN-0011277
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 3174
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | OLYMPIA
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | DI2064
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 2020001221
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #10
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | L005047
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #11
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 129973
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #12
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 14195813-4901
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #13
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 3923
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #14
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 1962
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------