Provider Demographics
NPI:1679170476
Name:COLEMAN, CHERYL LYNN (MA, RD, LD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MA, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 KENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-5222
Mailing Address - Country:US
Mailing Address - Phone:205-948-3846
Mailing Address - Fax:
Practice Address - Street 1:3935 N 75 W
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:UT
Practice Address - Zip Code:84318-4111
Practice Address - Country:US
Practice Address - Phone:435-359-0720
Practice Address - Fax:833-992-1993
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT117687574901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1669092169Medicaid