Basic Information
| Provider Information | |||||||||
| NPI: | 1114211158 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | SHERI | ||||||||
| MiddleName: | DEFREES | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RD, RDN, LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 FRIDAY CENTER DR | ||||||||
| Address2: | SUITE 2091, ROOM 2094 HEDRICK BUILDING | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275179499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849741191 | ||||||||
| FaxNumber: | 9849741311 | ||||||||
| Practice Location | |||||||||
| Address1: | 4200 LAKE BOONE TRL | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276076521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197841371 | ||||||||
| FaxNumber: | 9197841397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2011 | ||||||||
| LastUpdateDate: | 09/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133NN1002X | L003540 | NC | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 133V00000X | L003540 | NC | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | Q50654E853 | 01 | NC | MEDICARE PTAN | OTHER | Q50654A | 01 | NC | MEDICARE PTAN | OTHER |