Provider Demographics
NPI:1811569783
Name:KAYE, SLOANE BRANDON
Entity type:Individual
Prefix:
First Name:SLOANE
Middle Name:BRANDON
Last Name:KAYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 E 2ND ST APT 5
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5204
Mailing Address - Country:US
Mailing Address - Phone:646-488-6672
Mailing Address - Fax:
Practice Address - Street 1:3207 E 2ND ST APT 5
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5204
Practice Address - Country:US
Practice Address - Phone:646-488-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86175305133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered