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NPI Code Detail

MEDICARE: MS. SUSAN R TAYLOR RDN LD

MEDICARE:  MS. SUSAN R TAYLOR  RDN LD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian472SC

General Provider Information

NPI Number : 1578995742
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN R TAYLOR RDN LD
Provider Business Mailing Address
First Line : PO BOX 2195
Second Line :
City : MOUNT PLEASANT
State : SC
Zip : 29465-2195
Country : US
Telephone Number : 843-997-0273
Fax Number :
Provider Business Practice Location Address
First Line : 2230 ASHLEY CROSSING DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-5700
Country : US
Telephone Number : 843-766-1121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2013
Last Update Date : 07/30/2013

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Directions to “ MS. SUSAN R TAYLOR RDN LD” Practice Location

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