Provider Demographics
NPI:1114055415
Name:POLOMSKI, SUSAN (MS,RD,CDE)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:POLOMSKI
Suffix:
Gender:F
Credentials:MS,RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 GROVE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4785
Mailing Address - Country:US
Mailing Address - Phone:865-295-3223
Mailing Address - Fax:865-295-3244
Practice Address - Street 1:1405 GROVE RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4785
Practice Address - Country:US
Practice Address - Phone:865-295-3223
Practice Address - Fax:865-295-3244
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered