Provider Demographics
NPI:1265275432
Name:WHIDDON, CASSANDRA (RD)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:WHIDDON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 THORNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-5160
Mailing Address - Country:US
Mailing Address - Phone:517-214-2264
Mailing Address - Fax:
Practice Address - Street 1:6300 THORNWOOD DR
Practice Address - Street 2:
Practice Address - City:VAN BUREN TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48111-5160
Practice Address - Country:US
Practice Address - Phone:517-214-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered