Healthcare Provider Details

I. General information

NPI: 1548923220
Provider Name (Legal Business Name): JENEVIEVE PERRY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WILLIAM ST APT 24F
NEW YORK NY
10005-2946
US

IV. Provider business mailing address

15 WILLIAM ST APT 24F
NEW YORK NY
10005-2946
US

V. Phone/Fax

Practice location:
  • Phone: 386-562-8262
  • Fax:
Mailing address:
  • Phone: 386-562-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number86111723
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number86111723
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number86111723
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number86111723
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number86111723
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number86111723
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code133VN1401X
TaxonomyPediatric Critical Care Nutrition Registered Dietitian
License Number86111723
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number86111723
License Number StateNY
# 9
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86111723
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: