Provider Demographics
NPI:1023760881
Name:SHERMAN, TARA LYNN (RD, CSR, CDN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:RD, CSR, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 BARBARA TER
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-6623
Mailing Address - Country:US
Mailing Address - Phone:518-569-9352
Mailing Address - Fax:
Practice Address - Street 1:61 BARBARA TER
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-6623
Practice Address - Country:US
Practice Address - Phone:518-569-9352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074013246133N00000X
NY006617133N00000X
VT07413246133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal