Provider Demographics
NPI:1578867222
Name:HUNSUCKER, LISA JOAN (RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JOAN
Last Name:HUNSUCKER
Suffix:
Gender:F
Credentials:RD, CDN
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Other - Middle Name:
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Mailing Address - Street 1:998 CROOKED HILL RD
Mailing Address - Street 2:BLDG. 83 DIETARY DEPT.
Mailing Address - City:W BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1019
Mailing Address - Country:US
Mailing Address - Phone:631-761-2572
Mailing Address - Fax:631-761-2973
Practice Address - Street 1:998 CROOKED HILL RD
Practice Address - Street 2:BLDG. 83 DIETARY DEPT.
Practice Address - City:W BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1019
Practice Address - Country:US
Practice Address - Phone:631-761-2572
Practice Address - Fax:631-761-2973
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005599-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered