Provider Demographics
NPI:1770033482
Name:CARABALLOSA, BRANDON (RDN)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:CARABALLOSA
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 MILE SQUARE RD
Mailing Address - Street 2:2ND FLOOR - MEDICAL SUITE
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-2141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:880 MILE SQUARE RD
Practice Address - Street 2:2ND FLOOR - MEDICAL SUITE
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-2141
Practice Address - Country:US
Practice Address - Phone:914-207-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86060332133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered