Provider Demographics
NPI:1043482458
Name:CARDONICK, RANDI HOPE (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:HOPE
Last Name:CARDONICK
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 N BETHLEHEM PIKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOWER GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2655
Mailing Address - Country:US
Mailing Address - Phone:215-283-2833
Mailing Address - Fax:
Practice Address - Street 1:714 N BETHLEHEM PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOWER GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19002-2655
Practice Address - Country:US
Practice Address - Phone:215-283-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002329133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered