Basic Information
| Provider Information | |||||||||
| NPI: | 1538245576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLIER | ||||||||
| FirstName: | SHERRY | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.D., LD/N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 184 BAYBERRY PL | ||||||||
| Address2: | |||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334587703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618015712 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3501 WILLOUGHBY BLVD. | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722880304 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | ND 4849 | FL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | ND 4849 | 01 | FL | DIETITIAN/NUTRITIONIST | OTHER |