Provider Demographics
NPI:1831645472
Name:D'ANGELO, DANIELLE (RD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:D'ANGELO
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 1:3 SCOTT LN
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1270
Mailing Address - Country:US
Mailing Address - Phone:203-233-1126
Mailing Address - Fax:
Practice Address - Street 1:3 SCOTT LN
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1270
Practice Address - Country:US
Practice Address - Phone:203-233-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1097261133V00000X
CT1304133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02658OtherMEDICARE YNHH