Provider Demographics
NPI:1447014436
Name:OPPEDISANO, SUZANNE M (RDN)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:OPPEDISANO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FURWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3113
Mailing Address - Country:US
Mailing Address - Phone:516-633-1808
Mailing Address - Fax:
Practice Address - Street 1:16 FURWOOD DR
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-3113
Practice Address - Country:US
Practice Address - Phone:516-633-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered