Provider Demographics
NPI:1386934057
Name:DOMBROWSKI, SUSAN M (RD)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:DOMBROWSKI
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 1:9050 N CHURCH DR
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-4701
Mailing Address - Country:US
Mailing Address - Phone:440-292-0226
Mailing Address - Fax:
Practice Address - Street 1:9050 N CHURCH DR
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4701
Practice Address - Country:US
Practice Address - Phone:440-292-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD3356133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal