Healthcare Provider Details

I. General information

NPI: 1811243983
Provider Name (Legal Business Name): SHIRLEY WALSH SUTER RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE FL 5
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

375 DIXMYTH AVE FL 5
CINCINNATI OH
45220-2475
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-1800
  • Fax: 513-751-8638
Mailing address:
  • Phone: 513-862-1800
  • Fax: 513-751-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4772
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: