Healthcare Provider Details

I. General information

NPI: 1952679524
Provider Name (Legal Business Name): JAMIE KANDORA MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE DENISE SICKLES RD

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4070 HIGHWAY 17 BYPASS FOOD AND NUTRITION SERVICES
MURRELLS INLET SC
29576-5033
US

IV. Provider business mailing address

4070 HIGHWAY 17 BYPASS WACCAMAW HOSPITAL FOOD AND NUTRITION SERVICES
MURRELLS INLET SC
29576-5033
US

V. Phone/Fax

Practice location:
  • Phone: 843-520-8367
  • Fax:
Mailing address:
  • Phone: 843-520-8367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number761
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: