Healthcare Provider Details

I. General information

NPI: 1558808592
Provider Name (Legal Business Name): CASSANDRA ANNE SUAREZ MS, RD, LDN, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2017
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4904 ROSENA DR
CHARLOTTE NC
28227-3007
US

IV. Provider business mailing address

4904 ROSENA DR
CHARLOTTE NC
28227-3007
US

V. Phone/Fax

Practice location:
  • Phone: 978-376-0458
  • Fax:
Mailing address:
  • Phone: 978-376-0458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberL005407
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL005407
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4213
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: