Provider Demographics
NPI:1912328782
Name:GALLAGHER, ANGELA MICHELLE (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELLE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5247 INDIGO CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6053
Mailing Address - Country:US
Mailing Address - Phone:321-255-7841
Mailing Address - Fax:
Practice Address - Street 1:5247 INDIGO CROSSING DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6053
Practice Address - Country:US
Practice Address - Phone:321-255-7841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-21
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3586133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered