Provider Demographics
NPI:1285059873
Name:LIKAKIS, KERRI
Entity type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:
Last Name:LIKAKIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 STURGIS RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4071
Mailing Address - Country:US
Mailing Address - Phone:908-239-3542
Mailing Address - Fax:
Practice Address - Street 1:57 STURGIS RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4071
Practice Address - Country:US
Practice Address - Phone:908-239-3542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ967322133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered