Healthcare Provider Details

I. General information

NPI: 1568127199
Provider Name (Legal Business Name): SUZETTE MARIA DECASTRO MPH, MS, RDN, FAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 ROSEWOOD LN
GREENACRES FL
33463-3063
US

IV. Provider business mailing address

119 ROSEWOOD LN
GREENACRES FL
33463-3063
US

V. Phone/Fax

Practice location:
  • Phone: 561-714-1540
  • Fax:
Mailing address:
  • Phone: 561-714-1540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number2940
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number01061
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number2940
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number2940
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number2940
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number2940
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number01061
License Number StateRI
# 8
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2940
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: