Provider Demographics
NPI:1093885360
Name:HENRY, DORRELL MAY (M S, C D N)
Entity Type:Individual
Prefix:
First Name:DORRELL
Middle Name:MAY
Last Name:HENRY
Suffix:
Gender:F
Credentials:M S, C D N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-3209
Mailing Address - Country:US
Mailing Address - Phone:914-969-4734
Mailing Address - Fax:
Practice Address - Street 1:754 E 151ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3267
Practice Address - Country:US
Practice Address - Phone:718-402-2800
Practice Address - Fax:718-993-4395
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004956-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist