Basic Information
| Provider Information | |||||||||
| NPI: | 1699918268 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOKKINS | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | LYNCH | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RD,LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MILL ROAD SUITE 180 | ||||||||
| Address2: | |||||||||
| City: | FAIRHAVEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027195252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089732000 | ||||||||
| FaxNumber: | 5089732001 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 ROSEBROOK WAY 3RD FLOOR | ||||||||
| Address2: | |||||||||
| City: | WAREHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025711007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082734900 | ||||||||
| FaxNumber: | 5082734901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2009 | ||||||||
| LastUpdateDate: | 04/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 221 | MA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.