Basic Information
| Provider Information | |||||||||
| NPI: | 1811068729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMORUSO | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RD, CDE | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MAGGIULLI | ||||||||
| OtherFirstName: | SUZANNE | ||||||||
| OtherMiddleName: | C | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 21975 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403214281 | ||||||||
| FaxNumber: | 5403214282 | ||||||||
| Practice Location | |||||||||
| Address1: | 541 SUNSET LN STE 301 | ||||||||
| Address2: | |||||||||
| City: | CULPEPER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 227013979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408254557 | ||||||||
| FaxNumber: | 5408254566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 05/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 1811068729 | 05 | VA | MEDICAID | Q58686A | 01 | VA | MEDICARE | OTHER |