Healthcare Provider Details

I. General information

NPI: 1831600030
Provider Name (Legal Business Name): DAILY NUTRITION FOR LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 NE 8TH ST STE B1-707
BELLEVUE WA
98008
US

IV. Provider business mailing address

15600 NE 8TH ST STE B1-707
BELLEVUE WA
98008-3927
US

V. Phone/Fax

Practice location:
  • Phone: 425-830-1615
  • Fax: 425-830-1615
Mailing address:
  • Phone: 425-900-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ANAHID EDJLALI
Title or Position: REGISTERED DIETITIAN
Credential: MS RDN CDE
Phone: 425-900-3606