Provider Demographics
NPI:1104556794
Name:GARRY, JAMIE (MS, RD, LDN, CBDT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GARRY
Suffix:
Gender:F
Credentials:MS, RD, LDN, CBDT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:DOHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST RM 1308
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-726-2540
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST RM 1308
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3210133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered