Provider Demographics
NPI:1558079202
Name:DONOFRIO, MARISSA (MS, RD)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:DONOFRIO
Suffix:
Gender:F
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 1:2717 BELLEVUE AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3233
Mailing Address - Country:US
Mailing Address - Phone:315-460-0802
Mailing Address - Fax:
Practice Address - Street 1:2717 BELLEVUE AVE STE 6
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3233
Practice Address - Country:US
Practice Address - Phone:315-460-0802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered