Provider Demographics
NPI:1760220693
Name:HARRIS, CASSIE (RD)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:HARRIS
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 1:1139 BRAGGS WAY UNIT 1415
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4666
Mailing Address - Country:US
Mailing Address - Phone:443-566-2835
Mailing Address - Fax:
Practice Address - Street 1:1139 BRAGGS WAY UNIT 1415
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4666
Practice Address - Country:US
Practice Address - Phone:443-566-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered