Healthcare Provider Details

I. General information

NPI: 1154958080
Provider Name (Legal Business Name): DANIELLE CUDDEBACK RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 22ND AVE UNIT 307
SEATTLE WA
98122-6287
US

IV. Provider business mailing address

1717 22ND AVE UNIT 307
SEATTLE WA
98122-6287
US

V. Phone/Fax

Practice location:
  • Phone: 425-231-0194
  • Fax:
Mailing address:
  • Phone: 425-231-0194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86104339
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDIET.DI.61037761
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: