Healthcare Provider Details

I. General information

NPI: 1043853526
Provider Name (Legal Business Name): SUSAN E. SHERWOOD RDN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 BETHEL RD
COLUMBUS OH
43220-2003
US

IV. Provider business mailing address

PO BOX 284
WESTERVILLE OH
43086-0284
US

V. Phone/Fax

Practice location:
  • Phone: 614-203-1517
  • Fax:
Mailing address:
  • Phone: 614-203-1517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: SUSAN E SHERWOOD
Title or Position: OWNER
Credential: MS, RDN, LDN, CNSC
Phone: 614-203-1517