Provider Demographics
NPI:1285346452
Name:CORNELL, KAIDY BROOK (RDN)
Entity type:Individual
Prefix:MS
First Name:KAIDY
Middle Name:BROOK
Last Name:CORNELL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GREENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-8930
Mailing Address - Country:US
Mailing Address - Phone:401-743-0906
Mailing Address - Fax:
Practice Address - Street 1:18 N MAIN ST STE 304
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4926
Practice Address - Country:US
Practice Address - Phone:603-223-8119
Practice Address - Fax:603-223-8130
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered