Provider Demographics
NPI:1891596698
Name:CUSHMAN, CASSIE (RDN)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:CUSHMAN
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 N HAYDEN RD STE 123, PMB 149
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6670
Mailing Address - Country:US
Mailing Address - Phone:602-341-3709
Mailing Address - Fax:
Practice Address - Street 1:8020 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6666
Practice Address - Country:US
Practice Address - Phone:602-341-3709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT90229133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered