Provider Demographics
NPI:1740395243
Name:MANOS, DENISE (RD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MANOS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22300 BON BRAE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2236
Mailing Address - Country:US
Mailing Address - Phone:586-779-7901
Mailing Address - Fax:586-779-7114
Practice Address - Street 1:22300 BON BRAE ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2236
Practice Address - Country:US
Practice Address - Phone:586-779-7901
Practice Address - Fax:586-779-7114
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N67010Medicare ID - Type Unspecified