Provider Demographics
NPI:1194109322
Name:GALLO, TANYA (RDN, LDN, CDCES)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:GALLO
Suffix:
Gender:F
Credentials:RDN, LDN, CDCES
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:BELROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1407 SWEETBAY DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-5361
Mailing Address - Country:US
Mailing Address - Phone:508-212-6506
Mailing Address - Fax:
Practice Address - Street 1:1407 SWEETBAY DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-5361
Practice Address - Country:US
Practice Address - Phone:508-212-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60556488133V00000X
WADI60556488133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered