Provider Demographics
NPI:1184737900
Name:MATHEWS-BARKER, SUZANNE SHAW (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:SHAW
Last Name:MATHEWS-BARKER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 N MEADOW RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6344
Mailing Address - Country:US
Mailing Address - Phone:972-679-1319
Mailing Address - Fax:972-529-9988
Practice Address - Street 1:5113 N MEADOW RIDGE CIR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6344
Practice Address - Country:US
Practice Address - Phone:972-679-1319
Practice Address - Fax:972-529-9988
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT02890133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric