Provider Demographics
NPI:1982039475
Name:SHELLEY, DANAE L (RD, CDE)
Entity Type:Individual
Prefix:
First Name:DANAE
Middle Name:L
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:MISS
Other - First Name:DANAE
Other - Middle Name:L
Other - Last Name:ZARBUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:8915 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-4813
Mailing Address - Country:US
Mailing Address - Phone:206-764-4700
Mailing Address - Fax:
Practice Address - Street 1:3801 150TH AVE SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1668
Practice Address - Country:US
Practice Address - Phone:425-460-7140
Practice Address - Fax:425-460-7161
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005980133V00000X
WADI60563553133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164.005980OtherLICENSE #