Provider Demographics
NPI:1760683817
Name:MOORE, SUSAN SHARON (MS, RD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SHARON
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 PORTER ST APT 202
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2208
Mailing Address - Country:US
Mailing Address - Phone:703-209-3334
Mailing Address - Fax:
Practice Address - Street 1:901 PORTER ST APT 202
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-2208
Practice Address - Country:US
Practice Address - Phone:703-209-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered