Provider Demographics
NPI:1679304463
Name:MCANDREW, MACKENZIE (MS, RDN, LD/N)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:MCANDREW
Suffix:
Gender:F
Credentials:MS, RDN, LD/N
Other - Prefix:
Other - First Name:FERIDA
Other - Middle Name:
Other - Last Name:RAHIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1575 BUDLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1575 BUDLEIGH ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4404
Practice Address - Country:US
Practice Address - Phone:727-238-5188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12431133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered