Provider Demographics
NPI:1952679524
Name:KANDORA, JAMIE (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:KANDORA
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:DENISE
Other - Last Name:SICKLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4070 HIGHWAY 17 BYPASS
Mailing Address - Street 2:WACCAMAW HOSPITAL FOOD AND NUTRITION SERVICES
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5033
Mailing Address - Country:US
Mailing Address - Phone:843-520-8367
Mailing Address - Fax:
Practice Address - Street 1:4070 HIGHWAY 17 BYPASS
Practice Address - Street 2:FOOD AND NUTRITION SERVICES
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5033
Practice Address - Country:US
Practice Address - Phone:843-520-8367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC761133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered