Provider Demographics
NPI:1407553522
Name:MITCHELL, SUSAN LAW (RDN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LAW
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 TRUMBULL STREET
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379
Mailing Address - Country:US
Mailing Address - Phone:860-796-4489
Mailing Address - Fax:
Practice Address - Street 1:1145 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6055
Practice Address - Country:US
Practice Address - Phone:401-228-6010
Practice Address - Fax:401-228-8167
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered