Provider Demographics
NPI:1336946045
Name:GREEN, SUSAN MARIE (RDN, CDN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:GREEN
Suffix:
Gender:
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:GIESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:79 WESTFORT DR
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-3651
Mailing Address - Country:US
Mailing Address - Phone:203-232-4266
Mailing Address - Fax:
Practice Address - Street 1:79 WESTFORT DR
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-3651
Practice Address - Country:US
Practice Address - Phone:203-232-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13088133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered