Provider Demographics
NPI:1447013776
Name:JOHNSON, DANIELLE MARIE (MS, RDN, CDN, CPT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, RDN, CDN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 AVALON PINES DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-5126
Mailing Address - Country:US
Mailing Address - Phone:347-730-8370
Mailing Address - Fax:
Practice Address - Street 1:114 AVALON PINES DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-5126
Practice Address - Country:US
Practice Address - Phone:347-730-8370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86092357133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered