Provider Demographics
NPI:1457179491
Name:SCHMIDT, PERRY (MS, RD)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 CHRISTIANA ST APT 5
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-5441
Mailing Address - Country:US
Mailing Address - Phone:716-418-5185
Mailing Address - Fax:
Practice Address - Street 1:52 CHRISTIANA ST APT 5
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-5441
Practice Address - Country:US
Practice Address - Phone:716-418-5185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86300671133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered