Provider Demographics
NPI:1053556803
Name:CHANDLER, CYNTHIA ANN (RD)
Entity type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:ANN
Last Name:CHANDLER
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 1:3101 BARDSTOWN ROAD
Mailing Address - Street 2:NATIONAL CENTER FOR HOSPITALITY/SULLIVAN UNIVERSITY
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205
Mailing Address - Country:US
Mailing Address - Phone:502-456-6504
Mailing Address - Fax:
Practice Address - Street 1:3101 BARDSTOWN RD
Practice Address - Street 2:SULLIVAN UNIVERSITY
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3013
Practice Address - Country:US
Practice Address - Phone:502-456-6504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1477133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered