Provider Demographics
NPI:1033071766
Name:DEANGELIS, ELIZA
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:DEANGELIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 ELMDALE RD
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-1308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:177 ELMDALE RD
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:RI
Practice Address - Zip Code:02857-1308
Practice Address - Country:US
Practice Address - Phone:401-678-6762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN01629133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered