Provider Demographics
NPI:1528286655
Name:MOYERS, SUSAN B (PHD MPH LDN)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:MOYERS
Suffix:
Gender:F
Credentials:PHD MPH LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4522 W VILLAGE DR
Mailing Address - Street 2:SUITE 129
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-3429
Mailing Address - Country:US
Mailing Address - Phone:813-948-9040
Mailing Address - Fax:813-482-0014
Practice Address - Street 1:4522 W VILLAGE DR
Practice Address - Street 2:SUITE 129
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-3429
Practice Address - Country:US
Practice Address - Phone:813-948-9040
Practice Address - Fax:813-482-0014
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3395133NN1002X, 133V00000X, 133VN1006X
1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No1744R1102XOther Service ProvidersSpecialistResearch Study