Provider Demographics
NPI:1255208633
Name:DARBY, ANDREA (MS, RD, CSSD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:DARBY
Suffix:
Gender:F
Credentials:MS, RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7511 BERMUDA DUNES
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9545
Mailing Address - Country:US
Mailing Address - Phone:616-446-6303
Mailing Address - Fax:
Practice Address - Street 1:7511 BERMUDA DUNES
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9545
Practice Address - Country:US
Practice Address - Phone:616-446-6303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86171166133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered