Provider Demographics
NPI:1306314828
Name:LEE, SUZANNE D (RD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:D
Last Name:LEE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2017
Mailing Address - Country:US
Mailing Address - Phone:510-841-4525
Mailing Address - Fax:510-848-9970
Practice Address - Street 1:2905 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2017
Practice Address - Country:US
Practice Address - Phone:510-841-4525
Practice Address - Fax:510-848-9970
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal