Provider Demographics
NPI:1639774292
Name:MCCLELLAND, ANGELA EMMA (RD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:EMMA
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6190 RIVERWALK LANE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-246-7562
Mailing Address - Fax:
Practice Address - Street 1:6190 RIVERWALK LANE
Practice Address - Street 2:UNIT 2
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-246-7562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5858133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered