Provider Demographics
NPI:1225896954
Name:FALCON, CHANDLER (MS, RD, CSSD)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:FALCON
Suffix:
Gender:F
Credentials:MS, RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E OSBORNE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-4019
Mailing Address - Country:US
Mailing Address - Phone:318-344-8053
Mailing Address - Fax:
Practice Address - Street 1:8115 CYPRESS STAND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-5551
Practice Address - Country:US
Practice Address - Phone:813-828-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9192133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered