Healthcare Provider Details

I. General information

NPI: 1750602066
Provider Name (Legal Business Name): WENDY LEIGH CAAMANO MS, RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 116TH AVE NE
BELLEVUE WA
98004-3045
US

IV. Provider business mailing address

1907 223RD AVE SE
SAMMAMISH WA
98075-9572
US

V. Phone/Fax

Practice location:
  • Phone: 206-963-3203
  • Fax:
Mailing address:
  • Phone: 206-963-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60185009
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: