Provider Demographics
NPI:1588392716
Name:DUDEK, SUZANNE P (MS, CDN)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:P
Last Name:DUDEK
Suffix:
Gender:F
Credentials:MS, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 WYNNEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-2320
Mailing Address - Country:US
Mailing Address - Phone:914-740-8520
Mailing Address - Fax:
Practice Address - Street 1:446 WYNNEWOOD RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-2320
Practice Address - Country:US
Practice Address - Phone:914-740-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002365OtherCERTIFIED DIETICIAN NUTRITIONIST