Basic Information
| Provider Information | |||||||||
| NPI: | 1467888701 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASTERS | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | ALICE | ||||||||
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| Credential: | RD, CDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46 PRINCE ST | ||||||||
| Address2: | SUITE 3001 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146071023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855302050 | ||||||||
| FaxNumber: | 5855302398 | ||||||||
| Practice Location | |||||||||
| Address1: | 46 PRINCE ST | ||||||||
| Address2: | SUITE 3001 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146071023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855302050 | ||||||||
| FaxNumber: | 5855302398 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2013 | ||||||||
| LastUpdateDate: | 03/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 007839 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.