Provider Demographics
NPI:1669240115
Name:SUTTON, GLORIA (RD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4026
Mailing Address - Country:US
Mailing Address - Phone:917-509-6902
Mailing Address - Fax:
Practice Address - Street 1:978 ROUTE 45 STE 107
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3512
Practice Address - Country:US
Practice Address - Phone:845-362-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY998455133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered