Healthcare Provider Details

I. General information

NPI: 1124210414
Provider Name (Legal Business Name): SUSAN PETERS M.S., R.D., CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 VALLEY RD
CARMEL NY
10512-4355
US

IV. Provider business mailing address

41 BEEKMAN AVE
CROTON ON HUDSON NY
10520-2557
US

V. Phone/Fax

Practice location:
  • Phone: 914-844-6026
  • Fax:
Mailing address:
  • Phone: 914-862-2208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number001283-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: