Provider Demographics
NPI:1003301771
Name:D'ANGELO, MEREDITH (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:10538 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-8179
Mailing Address - Country:US
Mailing Address - Phone:440-317-1262
Mailing Address - Fax:
Practice Address - Street 1:5640 HUDSON INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-5011
Practice Address - Country:US
Practice Address - Phone:234-284-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.7905133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered