MEDICARE: SUE T SUGLIO RD, LD, CDE

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	133V00000X	Registered Dietitian	LD 1472	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00094086	OTHER	OH	RR MEDICARE

General Provider Information

NPI Number	:	1558363457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE T SUGLIO RD, LD, CDE

Provider Business Mailing Address
First Line	:	26908 DETROIT RD
Second Line	:	SUITE 301
City	:	WESTLAKE
State	:	OH
Zip	:	44145-2398
Country	:	US
Telephone Number	:	440-617-1823
Fax Number	:	440-617-0884

Provider Business Practice Location Address
First Line	:	26908 DETROIT RD
Second Line	:	SUITE 200
City	:	WESTLAKE
State	:	OH
Zip	:	44145-2398
Country	:	US
Telephone Number	:	440-250-8660
Fax Number	:	440-250-8639

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	05/10/2011

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