Healthcare Provider Details

I. General information

NPI: 1265355978
Provider Name (Legal Business Name): BRANDO CHACON MS, RD, CDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 WASHINGTON ST
BUFFALO NY
14203-2108
US

IV. Provider business mailing address

391 WASHINGTON ST
BUFFALO NY
14203-2108
US

V. Phone/Fax

Practice location:
  • Phone: 716-391-0176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86415211
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: