Provider Demographics
NPI:1154854545
Name:EDWARDS, SUSANNAH LIN (MS RDN LD)
Entity Type:Individual
Prefix:MS
First Name:SUSANNAH
Middle Name:LIN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS RDN LD
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Mailing Address - Street 1:1707 BLACK OAK LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1423
Mailing Address - Country:US
Mailing Address - Phone:240-449-3094
Mailing Address - Fax:240-489-4415
Practice Address - Street 1:10215 FERNWOOD RD
Practice Address - Street 2:SUITE 630
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1106
Practice Address - Country:US
Practice Address - Phone:240-449-3094
Practice Address - Fax:240-489-4415
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDDX4187133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered