Provider Demographics
NPI:1891255543
Name:SUHA, VINCENT GENE (MS, RD, CD)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:GENE
Last Name:SUHA
Suffix:
Gender:M
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 ROSEMARY AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-1842
Mailing Address - Country:US
Mailing Address - Phone:608-616-5295
Mailing Address - Fax:
Practice Address - Street 1:214 ROSEMARY AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1842
Practice Address - Country:US
Practice Address - Phone:608-616-5295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3027-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered