Provider Demographics
NPI:1407453210
Name:ZIKOS, SUSAN ANNE (MBA, RD, LDN, CDCES)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNE
Last Name:ZIKOS
Suffix:
Gender:F
Credentials:MBA, RD, LDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 EDELWEISS DR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9454
Mailing Address - Country:US
Mailing Address - Phone:412-302-9825
Mailing Address - Fax:
Practice Address - Street 1:229 EDELWEISS DR
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9454
Practice Address - Country:US
Practice Address - Phone:412-302-9825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004511133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered