Provider Demographics
NPI:1134305022
Name:MILLER, SUSAN H (RD, LDN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2402
Mailing Address - Country:US
Mailing Address - Phone:617-969-7115
Mailing Address - Fax:
Practice Address - Street 1:29 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-2402
Practice Address - Country:US
Practice Address - Phone:617-969-7115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1307133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered