Provider Demographics
NPI:1013926195
Name:BANDY, LINDA S (RD, LDN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:S
Last Name:BANDY
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7726 DANBURY DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4349
Mailing Address - Country:US
Mailing Address - Phone:630-985-4641
Mailing Address - Fax:630-985-4651
Practice Address - Street 1:6900 S MADISON ST
Practice Address - Street 2:STE 102
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5510
Practice Address - Country:US
Practice Address - Phone:630-655-3376
Practice Address - Fax:630-655-4676
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164000232133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232828OtherBLUE CROSS BLUE SHIELD
IL9408554OtherPRIVATE HEATHCARE SYSTEMS
IL9408554OtherPRIVATE HEATHCARE SYSTEMS