Provider Demographics
NPI:1699958942
Name:SWADENER, SUSAN SHARAGA (PHD, RD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SHARAGA
Last Name:SWADENER
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 SUNSET DR STE B3
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-4024
Mailing Address - Country:US
Mailing Address - Phone:805-528-1926
Mailing Address - Fax:
Practice Address - Street 1:2280 SUNSET DR STE B3
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-4024
Practice Address - Country:US
Practice Address - Phone:805-528-1926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R399376133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered