Provider Demographics
NPI:1457496101
Name:BAGLEY, SUSAN S (RD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:S
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 CONNOR RD # A
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1208
Mailing Address - Country:US
Mailing Address - Phone:845-446-4077
Mailing Address - Fax:
Practice Address - Street 1:554 CONNOR RD # A
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1208
Practice Address - Country:US
Practice Address - Phone:845-446-4077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered