Provider Demographics
NPI:1922332733
Name:YEOMAN, SUSAN B (LMT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:YEOMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 ALEXIS RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4822
Mailing Address - Country:US
Mailing Address - Phone:516-946-9417
Mailing Address - Fax:208-694-7383
Practice Address - Street 1:1 DAVISON AVE W
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2114
Practice Address - Country:US
Practice Address - Phone:516-946-9417
Practice Address - Fax:208-694-7383
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
NY013288174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No133N00000XDietary & Nutritional Service ProvidersNutritionist