Provider Demographics
NPI:1497867592
Name:CARLIS, CHERRY EVON (RD, LD/N)
Entity type:Individual
Prefix:MS
First Name:CHERRY
Middle Name:EVON
Last Name:CARLIS
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:MS
Other - First Name:CHERRY
Other - Middle Name:ALFORD
Other - Last Name:CARLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LD/N
Mailing Address - Street 1:20170 NW 9TH DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3422
Mailing Address - Country:US
Mailing Address - Phone:954-433-0611
Mailing Address - Fax:
Practice Address - Street 1:1201 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1624
Practice Address - Country:US
Practice Address - Phone:305-324-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 922133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered