Provider Demographics
NPI:1225247166
Name:CROSBY, SUSAN M (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:CROSBY
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 1:9172 GLENASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-9032
Mailing Address - Country:US
Mailing Address - Phone:704-641-3713
Mailing Address - Fax:704-895-9870
Practice Address - Street 1:16501 NORTHCROSS DR
Practice Address - Street 2:SUITE D
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5000
Practice Address - Country:US
Practice Address - Phone:704-895-9865
Practice Address - Fax:704-895-9870
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003065133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered