Healthcare Provider Details

I. General information

NPI: 1336066778
Provider Name (Legal Business Name): MICHELLE THERESE PUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHELLY PUGH RDN

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6318 45TH AVE. SW
SEATTLE WA
98136
US

IV. Provider business mailing address

6318 45TH AVE SW
SEATTLE WA
98136
US

V. Phone/Fax

Practice location:
  • Phone: 206-660-3254
  • Fax:
Mailing address:
  • Phone: 206-660-3254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number722794
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: