Provider Demographics
NPI:1164698791
Name:BOYD, SUSAN ELIZABETH (MS,RD,LDN,CDOE)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:BOYD
Suffix:
Gender:F
Credentials:MS,RD,LDN,CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 STEERE FARM RD
Mailing Address - Street 2:
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859-4008
Mailing Address - Country:US
Mailing Address - Phone:401-568-8434
Mailing Address - Fax:401-568-3059
Practice Address - Street 1:759 STEERE FARM RD
Practice Address - Street 2:
Practice Address - City:PASCOAG
Practice Address - State:RI
Practice Address - Zip Code:02859-4008
Practice Address - Country:US
Practice Address - Phone:401-568-8434
Practice Address - Fax:401-568-3059
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00114133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered