Provider Demographics
NPI:1447047261
Name:DEVITO, GABRIELLE ANNE (RDN)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ANNE
Last Name:DEVITO
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 COYOTE TRL
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3142
Mailing Address - Country:US
Mailing Address - Phone:815-474-7870
Mailing Address - Fax:
Practice Address - Street 1:1027 COYOTE TRL
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-3142
Practice Address - Country:US
Practice Address - Phone:815-474-7870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.011271133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered