Provider Demographics
NPI:1053540377
Name:LEWIS-HACKLER, SHARON LEIGH (MS, RD, LDN, LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LEIGH
Last Name:LEWIS-HACKLER
Suffix:
Gender:F
Credentials:MS, RD, LDN, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 WEST ARLINGTON BLVD, SUITE 106
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3796
Mailing Address - Country:US
Mailing Address - Phone:252-689-6303
Mailing Address - Fax:252-689-6304
Practice Address - Street 1:1540 E ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5870
Practice Address - Country:US
Practice Address - Phone:252-364-2806
Practice Address - Fax:252-364-2863
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9133V00000X
NCL002396133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1822ROtherBCBS NC
NC1822ROtherBCBS NC