Provider Demographics
NPI:1568127199
Name:DECASTRO, SUZETTE MARIA (MPH, MS, RDN, FAND)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:MARIA
Last Name:DECASTRO
Suffix:
Gender:F
Credentials:MPH, MS, RDN, FAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 ROSEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3063
Mailing Address - Country:US
Mailing Address - Phone:561-714-1540
Mailing Address - Fax:
Practice Address - Street 1:119 ROSEWOOD LN
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3063
Practice Address - Country:US
Practice Address - Phone:561-714-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2940132700000X, 133NN1002X, 133VN1004X, 133VN1005X, 133VN1101X, 133V00000X
RI01061133N00000X, 133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management