Provider Demographics
NPI:1093887507
Name:GAY, SUSAN ELIZAETH (RD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELIZAETH
Last Name:GAY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:201 MAIN ST
Mailing Address - Street 2:5
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4761
Mailing Address - Country:US
Mailing Address - Phone:207-854-3663
Mailing Address - Fax:207-854-3664
Practice Address - Street 1:201 MAIN ST
Practice Address - Street 2:5
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4761
Practice Address - Country:US
Practice Address - Phone:207-854-3663
Practice Address - Fax:207-854-3664
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME242271133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered