Provider Demographics
NPI:1346024650
Name:FIORDALIS, TONI LYNN (RDN)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:LYNN
Last Name:FIORDALIS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:LYNN
Other - Last Name:PORTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3836 S FINDLAY ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3836 S FINDLAY ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2244
Practice Address - Country:US
Practice Address - Phone:206-618-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61461278133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered