Tanisha Bandoo, MS,RDN,CDN,LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

010561 Issued in NY

Practice address

2630 W Broward Blvd Ste 203
Fort Lauderdale, FL 33312

Phone

(914) 315-4136

NPI assigned

Jul 9, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Backcountry Wellness LLC

  • Psychiatric Residential Treatment Facility
  • Greenwich, CT
  • NPI 1174292460
  NPD (past)
• Backcountry Wellness LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Greenwich, CT
  • NPI 1568959815
  NPD (past)
• Fay Nutrition

  • Registered Dietitian
  • San Francisco, CA
  • NPI 1104334465

  Dietitian, Registered

  NPD (past)
• Nourish, Inc.

  • Registered Dietitian
  • Austin, TX
  • NPI 1558097824

  Dietitian, Registered

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1821669847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630 W BROWARD BLVD STE 203",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333121315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 W BROWARD BLVD STE 203",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "33312",
            "telephone_number": "914-315-4136"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10600 Chevrolet Way, St 228",
            "address_purpose": "LOCATION",
            "city": "Estero",
            "state": "FL",
            "postal_code": "33928",
            "country_code": "US",
            "telephone_number": "941-500-2610",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "57 W 57th St Ste 1101",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100192814",
            "country_code": "US",
            "telephone_number": "914-483-5175",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANDOO",
        "first_name": "TANISHA",
        "credential": "MS,RDN,CDN,LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-09",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.012334",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "LD007465",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "10677",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CT",
            "license": "2043",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT90869",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "010561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tanisha@pathnutritiontherapy.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2630 W Broward Blvd Ste 203",
            "city": "Fort Lauderdale",
            "state": "FL",
            "country_code": "US",
            "postal_code": "333121315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Naomi Hope Balingcongan
• Cherie Ballard
• Shelby Ballaron, PA-C
• Natalee B Balseiro, LMHC
• Mia Isabel Banag
• Ana Andreea Banica, PA-C
• Sophia Bankole, IMH
• Sarah Banks
• Stephanie Lauren Banks
• Rose Bannon

• Registered Dietitian in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.