Provider Demographics
NPI:1528785920
Name:DANGELO, AMBER (RDN, LD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:DANGELO
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SW GOSFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-7929
Mailing Address - Country:US
Mailing Address - Phone:479-366-1049
Mailing Address - Fax:
Practice Address - Street 1:275 CONVENTION DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4257
Practice Address - Country:US
Practice Address - Phone:479-366-1049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1060133V00000X
NCL007093133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered