Provider Demographics
NPI:1699564104
Name:ELY, ANGELINA R (RD)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:R
Last Name:ELY
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 TERRY AVE UNIT 608
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1982
Mailing Address - Country:US
Mailing Address - Phone:208-641-4935
Mailing Address - Fax:
Practice Address - Street 1:1420 TERRY AVE UNIT 608
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1982
Practice Address - Country:US
Practice Address - Phone:208-641-4935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86044255133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered