Provider Demographics
NPI:1104944826
Name:MICHELI, SUSAN BURKY (MS, RD, CDE)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:BURKY
Last Name:MICHELI
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 POOLE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-2607
Mailing Address - Country:US
Mailing Address - Phone:530-671-2848
Mailing Address - Fax:
Practice Address - Street 1:1510 POOLE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2607
Practice Address - Country:US
Practice Address - Phone:530-671-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22415ZMedicare ID - Type Unspecified