Provider Demographics
NPI:1447083290
Name:MAST, SHERRY ANN (NUTRITIONIST)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:ANN
Last Name:MAST
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 MATTHEW ST
Mailing Address - Street 2:
Mailing Address - City:WATSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17777-1023
Mailing Address - Country:US
Mailing Address - Phone:570-765-3049
Mailing Address - Fax:
Practice Address - Street 1:802 MATTHEW ST
Practice Address - Street 2:
Practice Address - City:WATSONTOWN
Practice Address - State:PA
Practice Address - Zip Code:17777-1023
Practice Address - Country:US
Practice Address - Phone:570-765-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist