Provider Demographics
NPI:1417283870
Name:WILLIAMS, SUSAN DAUM (MS,RD,LD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DAUM
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17294 122ND DR N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-5203
Mailing Address - Country:US
Mailing Address - Phone:561-762-2784
Mailing Address - Fax:
Practice Address - Street 1:17294 122ND DR N
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33478-5203
Practice Address - Country:US
Practice Address - Phone:561-762-2784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 1973133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered