Provider Demographics
NPI:1255687471
Name:BIRES, SUSAN LEI (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LEI
Last Name:BIRES
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 1:404 ATKINSON LN
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2811
Mailing Address - Country:US
Mailing Address - Phone:215-260-1864
Mailing Address - Fax:
Practice Address - Street 1:404 ATKINSON LN
Practice Address - Street 2:
Practice Address - City:MAPLE GLEN
Practice Address - State:PA
Practice Address - Zip Code:19002-2811
Practice Address - Country:US
Practice Address - Phone:215-260-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered