MEDICARE: DR. SUSAN B MOYERS PHD. MPH. LDN.

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	133NN1002X	Nutrition Education Nutritionist	ND3395	FL
2	133V00000X	Registered Dietitian	ND3395	FL
3	133VN1006X	Metabolic Nutrition Registered Dietitian	ND3395	FL
4	1744R1102X	Research Study Specialist

General Provider Information

NPI Number	:	1528286655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN B MOYERS PHD. MPH. LDN.

Provider Business Mailing Address
First Line	:	4522 W VILLAGE DR
Second Line	:	SUITE 129
City	:	TAMPA
State	:	FL
Zip	:	33624-3429
Country	:	US
Telephone Number	:	813-948-9040
Fax Number	:	813-482-0014

Provider Business Practice Location Address
First Line	:	4522 W VILLAGE DR
Second Line	:	SUITE 129
City	:	TAMPA
State	:	FL
Zip	:	33624-3429
Country	:	US
Telephone Number	:	813-948-9040
Fax Number	:	813-482-0014

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	11/12/2013

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