Provider Demographics
NPI:1558808592
Name:SUAREZ, CASSANDRA ANNE (MS, RD, LDN, CPT)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:ANNE
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:MS, RD, LDN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4904 ROSENA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-3007
Mailing Address - Country:US
Mailing Address - Phone:978-376-0458
Mailing Address - Fax:
Practice Address - Street 1:4904 ROSENA DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-3007
Practice Address - Country:US
Practice Address - Phone:978-376-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-29
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005407133VN1006X, 133V00000X
MA4213133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic