Provider Demographics
NPI:1134450265
Name:COPP, SUZANNE D (MS)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:D
Last Name:COPP
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TROUT BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2650
Mailing Address - Country:US
Mailing Address - Phone:203-258-5688
Mailing Address - Fax:203-364-1685
Practice Address - Street 1:10 TROUT BROOK CIR
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2650
Practice Address - Country:US
Practice Address - Phone:203-258-5688
Practice Address - Fax:203-364-1685
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist