MEDICARE: MADISON SYDNEY CHEEVER MPH, RD, LDN, CHES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86143452	AL
2	133V00000X	Registered Dietitian	DT91186	TX
3	133V00000X	Registered Dietitian	164011636	IL
4	133V00000X	Registered Dietitian	5657-NU-NU	MA
5	133V00000X	Registered Dietitian	5448	MN

General Provider Information

NPI Number	:	1275284200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON SYDNEY CHEEVER MPH, RD, LDN, CHES

Provider Business Mailing Address
First Line	:	4455 VILLAGE LAKE DR SE UNIT 85
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372-3086
Country	:	US
Telephone Number	:	775-685-6998
Fax Number	:

Provider Business Practice Location Address
First Line	:	4455 VILLAGE LAKE DR SE UNIT 85
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372-3086
Country	:	US
Telephone Number	:	775-685-6998
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2022
Last Update Date	:	04/06/2026

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