Provider Demographics
NPI:1689283574
Name:BRANDLEY, KASSANDRA (RDN)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:BRANDLEY
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 1:2485 N 450 W
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84414-7209
Mailing Address - Country:US
Mailing Address - Phone:801-391-4640
Mailing Address - Fax:
Practice Address - Street 1:2485 N 450 W
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:UT
Practice Address - Zip Code:84414-7209
Practice Address - Country:US
Practice Address - Phone:801-391-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered