Provider Demographics
NPI:1730843715
Name:DVORACHEK, DONNA (MS)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:DVORACHEK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 PROSPECT AVE
Mailing Address - Street 2:UNIT 10E
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-343-2654
Mailing Address - Fax:
Practice Address - Street 1:307 PROSPECT AVE
Practice Address - Street 2:UNIT 10E
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-343-2654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education