Provider Demographics
NPI:1245047141
Name:PIERRE, TERRY EDWARD (MS,RD,CDN)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:EDWARD
Last Name:PIERRE
Suffix:
Gender:M
Credentials:MS,RD,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17319 SAYRES AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-4022
Mailing Address - Country:US
Mailing Address - Phone:929-602-0455
Mailing Address - Fax:
Practice Address - Street 1:17319 SAYRES AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-4022
Practice Address - Country:US
Practice Address - Phone:929-602-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01241101133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered