Provider Demographics
NPI:1710601372
Name:CASSANDRA L TRAYNOR
Entity Type:Organization
Organization Name:CASSANDRA L TRAYNOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CDN
Authorized Official - Phone:845-641-3767
Mailing Address - Street 1:74 LAFAYETTE AVE STE 202
Mailing Address - Street 2:STE 202, #506
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5564
Mailing Address - Country:US
Mailing Address - Phone:845-641-3767
Mailing Address - Fax:845-474-7077
Practice Address - Street 1:974 NY-45 SUITE 2000
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-1097
Practice Address - Country:US
Practice Address - Phone:845-641-3767
Practice Address - Fax:845-474-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty