Provider Demographics
NPI:1285965541
Name:SHAW, CHERYL (RD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E BOYD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-2816
Mailing Address - Country:US
Mailing Address - Phone:317-462-5252
Mailing Address - Fax:317-462-8010
Practice Address - Street 1:300 E BOYD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-2816
Practice Address - Country:US
Practice Address - Phone:317-462-5252
Practice Address - Fax:317-462-8010
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000603A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered