=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801699525
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KALEIDOSCOPE NUTRITION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2025
-----------------------------------------------------
Last Update Date | 03/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8736 3RD AVE NW
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98117-3109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-627-0336
-----------------------------------------------------
Fax | 206-656-5556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8736 3RD AVE NW
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98117-3109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-627-0336
-----------------------------------------------------
Fax | 206-656-5556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, NUTRITIONIST
-----------------------------------------------------
Name | DANIELA GHELEVA
-----------------------------------------------------
Credential | PHD, RDN
-----------------------------------------------------
Telephone | 206-745-0336
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------