Provider Demographics
NPI:1699314302
Name:GENYK, SUZANNE R (MPH, RD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:R
Last Name:GENYK
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2762 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6914
Mailing Address - Country:US
Mailing Address - Phone:734-255-1857
Mailing Address - Fax:
Practice Address - Street 1:2762 PAGE AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6914
Practice Address - Country:US
Practice Address - Phone:734-255-1857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
MI86089300133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered