Provider Demographics
NPI:1508241332
Name:MOORE, DANIELL
Entity Type:Individual
Prefix:MRS
First Name:DANIELL
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:KROTJE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:845 ROUTES 5 & 20
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:NY
Mailing Address - Zip Code:14081
Mailing Address - Country:US
Mailing Address - Phone:716-951-7252
Mailing Address - Fax:716-951-7227
Practice Address - Street 1:100 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-1111
Practice Address - Country:US
Practice Address - Phone:716-951-7252
Practice Address - Fax:716-951-7227
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1067493133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered