Provider Demographics
NPI:1821347543
Name:SPORTE, DANIELLE (RD)
Entity Type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:
Last Name:SPORTE
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 1:550 CHERRY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4748
Mailing Address - Country:US
Mailing Address - Phone:616-235-7272
Mailing Address - Fax:616-235-7506
Practice Address - Street 1:550 CHERRY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4748
Practice Address - Country:US
Practice Address - Phone:616-235-7272
Practice Address - Fax:616-235-7506
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI864992OtherCOMMISSION ON DIETETIC REGISTRATION