Provider Demographics
NPI:1346874641
Name:BERRY, AMY JEAN (MS, RD, CNSC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:BERRY
Suffix:
Gender:F
Credentials:MS, RD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 HIDDEN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-9467
Mailing Address - Country:US
Mailing Address - Phone:434-996-0507
Mailing Address - Fax:866-421-3337
Practice Address - Street 1:1221 HIDDEN LAKES DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9467
Practice Address - Country:US
Practice Address - Phone:843-872-2090
Practice Address - Fax:866-421-3337
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered