Provider Demographics
NPI:1679198949
Name:SUSTERSIC, LYNNE (RDN)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:SUSTERSIC
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 CLOVER CIR
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9525
Mailing Address - Country:US
Mailing Address - Phone:440-821-7938
Mailing Address - Fax:
Practice Address - Street 1:1995 CLOVER CIR
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:OH
Practice Address - Zip Code:44233-9525
Practice Address - Country:US
Practice Address - Phone:440-821-7938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered