Provider Demographics
NPI:1548634561
Name:BANDY, VICTORIA (RD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BANDY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SONOMA CT
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-5943
Mailing Address - Country:US
Mailing Address - Phone:540-532-3271
Mailing Address - Fax:
Practice Address - Street 1:103 SONOMA CT
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-5943
Practice Address - Country:US
Practice Address - Phone:540-532-3271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1091137133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered