Provider Demographics
NPI:1043655061
Name:NELSON, SUZANNE A (SCD, RD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:A
Last Name:NELSON
Suffix:
Gender:F
Credentials:SCD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 PIEDMONT AVE
Mailing Address - Street 2:SIMPSON CENTER RM 170D
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-2325
Mailing Address - Country:US
Mailing Address - Phone:510-642-9041
Mailing Address - Fax:
Practice Address - Street 1:2227 PIEDMONT AVE
Practice Address - Street 2:SIMPSON CENTER RM 170D
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-2325
Practice Address - Country:US
Practice Address - Phone:510-642-9041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
708177133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered