Provider Demographics
NPI:1962523597
Name:GLAZE, SHERI LYNN (RDCD)
Entity type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:LYNN
Last Name:GLAZE
Suffix:
Gender:F
Credentials:RDCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 RUDGATE DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8408
Mailing Address - Country:US
Mailing Address - Phone:317-272-1952
Mailing Address - Fax:317-272-1953
Practice Address - Street 1:1644 RUDGATE DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8408
Practice Address - Country:US
Practice Address - Phone:317-272-1952
Practice Address - Fax:317-272-1953
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN723647133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric