Provider Demographics
NPI:1407151012
Name:SANTUCCI, RICHARD (RD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:SANTUCCI
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3100
Mailing Address - Country:US
Mailing Address - Phone:615-425-4200
Mailing Address - Fax:800-546-2104
Practice Address - Street 1:3874 PAXTON AVE UNIT 9647
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-7526
Practice Address - Country:US
Practice Address - Phone:502-530-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3825-29133V00000X
MN4907133V00000X
KS2712133V00000X
AK159679133V00000X
SD0813133V00000X
IA128730133V00000X
MS2625133V00000X
OHLD.08248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered