Provider Demographics
NPI:1205367760
Name:SHAPIRO, SUZANNE (MS, RD, CD-N)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:MS, RD, CD-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-6629
Mailing Address - Country:US
Mailing Address - Phone:203-434-0595
Mailing Address - Fax:
Practice Address - Street 1:7 GLENVILLE RD STE 203
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5330
Practice Address - Country:US
Practice Address - Phone:203-434-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-418770133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered