Provider Demographics
NPI:1356129571
Name:DEANGELO, LISA KAY (RD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:DEANGELO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:KAY
Other - Last Name:DEANGELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISA KAY SAYERS
Mailing Address - Street 1:140 SAYERS ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-9358
Mailing Address - Country:US
Mailing Address - Phone:276-385-8348
Mailing Address - Fax:
Practice Address - Street 1:388 BEN BOLT AVE
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-5386
Practice Address - Country:US
Practice Address - Phone:276-202-5079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
948481133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered