Provider Demographics
NPI:1982214821
Name:DAL, KERRY PRUNOTTO (RD)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:PRUNOTTO
Last Name:DAL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:MARGARET
Other - Last Name:PRUNOTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8403 SUGAR PINE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090
Mailing Address - Country:US
Mailing Address - Phone:315-657-3365
Mailing Address - Fax:
Practice Address - Street 1:8403 SUGAR PINE CIRCLE
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090
Practice Address - Country:US
Practice Address - Phone:315-657-3365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty