Healthcare Provider Details

I. General information

NPI: 1114123270
Provider Name (Legal Business Name): SUSAN M MAURER MS, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CORPORATE PARK DRIVE
TRUMBULL CT
06611
US

IV. Provider business mailing address

310 TSCHIFFELY SQUARE RD
GAITHERSBURG MD
20878-5682
US

V. Phone/Fax

Practice location:
  • Phone: 203-459-5100
  • Fax:
Mailing address:
  • Phone: 301-990-0662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: