Provider Demographics
NPI:1477762003
Name:RYSEDORPH, SUSAN SHEIDLER (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:SHEIDLER
Last Name:RYSEDORPH
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 1:8997 SHADY LEAF CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7414
Mailing Address - Country:US
Mailing Address - Phone:901-759-0399
Mailing Address - Fax:
Practice Address - Street 1:310 GERMANTOWN BEND CV
Practice Address - Street 2:SUITE 101
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4267
Practice Address - Country:US
Practice Address - Phone:901-759-9337
Practice Address - Fax:901-759-7967
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000000978133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered