Healthcare Provider Details

I. General information

NPI: 1518655695
Provider Name (Legal Business Name): SUZANNE DOAD RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 OLD MALLARD CREEK RD
CHARLOTTE NC
28262-2238
US

IV. Provider business mailing address

10531 SWEETHAVEN LN
HARRISBURG NC
28075-9701
US

V. Phone/Fax

Practice location:
  • Phone: 704-380-4655
  • Fax:
Mailing address:
  • Phone: 980-297-3953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL005548
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: