Provider Demographics
NPI:1669975801
Name:OBRIEN, RANDI Y (RDN)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:Y
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 THIMBLE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-5727
Mailing Address - Country:US
Mailing Address - Phone:203-376-3957
Mailing Address - Fax:
Practice Address - Street 1:800 BOSTON POST RD FL 1
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2747
Practice Address - Country:US
Practice Address - Phone:203-777-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
636583OtherRDN REGISTRATION NUMBER