Provider Demographics
NPI:1831292705
Name:GEBO, SUSAN CLAIRE (RD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CLAIRE
Last Name:GEBO
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 1:769 FARMINGTON AVE
Mailing Address - Street 2:STE D, BOX 12
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2366
Mailing Address - Country:US
Mailing Address - Phone:860-930-9022
Mailing Address - Fax:
Practice Address - Street 1:769 FARMINGTON AVE
Practice Address - Street 2:STE D, BOX 12
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2366
Practice Address - Country:US
Practice Address - Phone:860-930-9022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000176133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered