Provider Demographics
NPI:1710445358
Name:MITCHELL, SUSAN (PHD, RDN, LDN, FAND)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD, RDN, LDN, FAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 LAKE HOWELL RD # 246
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1033
Mailing Address - Country:US
Mailing Address - Phone:407-629-1101
Mailing Address - Fax:407-629-1069
Practice Address - Street 1:1690 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2036
Practice Address - Country:US
Practice Address - Phone:407-629-1101
Practice Address - Fax:407-629-1069
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-02
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0001949133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered