Healthcare Provider Details

I. General information

NPI: 1760601835
Provider Name (Legal Business Name): SUZANNE LYNELLE SMITH MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

6787 RUWES OAK DR
CINCINNATI OH
45248-1030
US

V. Phone/Fax

Practice location:
  • Phone: 513-872-7711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberLD 5275
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: