Healthcare Provider Details

I. General information

NPI: 1407151012
Provider Name (Legal Business Name): RICHARD SANTUCCI RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3874 PAXTON AVE UNIT 9647
CINCINNATI OH
45209-7526
US

IV. Provider business mailing address

2620 ELM HILL PIKE
NASHVILLE TN
37214-3100
US

V. Phone/Fax

Practice location:
  • Phone: 502-530-4812
  • Fax:
Mailing address:
  • Phone: 615-425-4200
  • Fax: 800-546-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3825-29
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4907
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2712
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number159679
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0813
License Number StateSD
# 6
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number128730
License Number StateIA
# 7
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2625
License Number StateMS
# 8
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.08248
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: