Provider Demographics
NPI:1235505959
Name:JACOB, SHERIN (MA, RDN, LD)
Entity type:Individual
Prefix:MS
First Name:SHERIN
Middle Name:
Last Name:JACOB
Suffix:
Gender:
Credentials:MA, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10430 MORADO CIR APT 2233
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5881
Mailing Address - Country:US
Mailing Address - Phone:832-283-7530
Mailing Address - Fax:
Practice Address - Street 1:10430 MORADO CIR APT 2233
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5881
Practice Address - Country:US
Practice Address - Phone:832-283-7530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2025-03-21
Deactivation Date:2016-04-07
Deactivation Code:
Reactivation Date:2025-03-21
Provider Licenses
StateLicense IDTaxonomies
TXDT83369133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered