Provider Demographics
NPI:1295765998
Name:BANDY, CHRISTINE ELIZABETH (MS,RD,LD/N,CDE)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:BANDY
Suffix:
Gender:F
Credentials:MS,RD,LD/N,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 QUAIL PT
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8381
Mailing Address - Country:US
Mailing Address - Phone:561-371-8401
Mailing Address - Fax:
Practice Address - Street 1:12300 ALTERNATE A1A, 108
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-371-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2168133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN0048Medicare ID - Type UnspecifiedMEDICAL NUTRITION THERAPY