Provider Demographics
NPI:1710701610
Name:AXELROD, KERRI (RD, LDN)
Entity type:Individual
Prefix:MS
First Name:KERRI
Middle Name:
Last Name:AXELROD
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LIBERTY SQUARE PMB 6046
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109
Mailing Address - Country:US
Mailing Address - Phone:202-494-8250
Mailing Address - Fax:
Practice Address - Street 1:3428 EL RADO CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-4621
Practice Address - Country:US
Practice Address - Phone:202-494-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN7873133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered