Provider Demographics
NPI:1083104616
Name:SINGARAJU, AUDREY (RD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:SINGARAJU
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:TWIFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 CEDAR AVE S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-6047
Mailing Address - Country:US
Mailing Address - Phone:720-771-5030
Mailing Address - Fax:
Practice Address - Street 1:16045 1ST AVE S
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1401
Practice Address - Country:US
Practice Address - Phone:206-965-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86063563133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered