Healthcare Provider Details

I. General information

NPI: 1649528274
Provider Name (Legal Business Name): SUZANNE BEACH R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 NEW HARWINTON ROAD
TORRINGTON CT
06790-5931
US

IV. Provider business mailing address

723 NEW HARWINTON ROAD
TORRINGTON CT
06790-5931
US

V. Phone/Fax

Practice location:
  • Phone: 860-496-8461
  • Fax:
Mailing address:
  • Phone: 860-496-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number896823
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: