Provider Demographics
NPI:1154958080
Name:CUDDEBACK, DANIELLE (RDN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:CUDDEBACK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 22ND AVE UNIT 307
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6287
Mailing Address - Country:US
Mailing Address - Phone:425-231-0194
Mailing Address - Fax:
Practice Address - Street 1:1717 22ND AVE UNIT 307
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-6287
Practice Address - Country:US
Practice Address - Phone:425-231-0194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86104339133V00000X
WADIET.DI.61037761133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered