Healthcare Provider Details

I. General information

NPI: 1780508176
Provider Name (Legal Business Name): CHASSIDY MARTIN RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 ROBERTS COVE RD
RAYNE LA
70578-8907
US

IV. Provider business mailing address

6140 ROBERTS COVE RD
RAYNE LA
70578-8907
US

V. Phone/Fax

Practice location:
  • Phone: 337-789-3579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2474
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: