MEDICARE: DR. SUSAN J VANNUCCI PHD, RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1006X	Metabolic Nutrition Registered Dietitian	716153

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	716153	OTHER		ADA

General Provider Information

NPI Number	:	1184850950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN J VANNUCCI PHD, RD

Provider Business Mailing Address
First Line	:	315 W 106TH ST APT 3D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-3473
Country	:	US
Telephone Number	:	212-932-1727
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 W 106TH ST APT 3D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-3473
Country	:	US
Telephone Number	:	212-932-1727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2009
Last Update Date	:	06/06/2009

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