Provider Demographics
NPI:1073767075
Name:BERRY, DAWN PATRICIA (RD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:PATRICIA
Last Name:BERRY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:PATRICIA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:215 WASHINGTON ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3329
Mailing Address - Country:US
Mailing Address - Phone:315-783-6810
Mailing Address - Fax:
Practice Address - Street 1:215 WASHINGTON ST
Practice Address - Street 2:SUITE 108
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3329
Practice Address - Country:US
Practice Address - Phone:315-783-6810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006277133V00000X
NY06277133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006377OtherNYS CERTIFICATION (CERTIFIED DIETITIAN/ NUTRITIONIST)
896001OtherREGISTERED DIETITIAN REGISTRATION NUMBER