Provider Demographics
NPI:1609873975
Name:SUTTON, LYNN (RD, CDN, CDE)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:RD, CDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 WASHINGTON AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1098
Mailing Address - Country:US
Mailing Address - Phone:518-489-4704
Mailing Address - Fax:518-489-0512
Practice Address - Street 1:1365 WASHINGTON AVE
Practice Address - Street 2:STE 300
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1098
Practice Address - Country:US
Practice Address - Phone:518-489-4704
Practice Address - Fax:518-489-0512
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD7053Medicare ID - Type Unspecified