Provider Demographics
NPI:1780462432
Name:ELSALEH, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ELSALEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6246 SPENCERS GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5058
Mailing Address - Country:US
Mailing Address - Phone:832-868-0762
Mailing Address - Fax:
Practice Address - Street 1:6246 SPENCERS GLEN WAY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-5058
Practice Address - Country:US
Practice Address - Phone:832-868-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered