Provider Demographics
NPI:1962698803
Name:SUTAY, REBECCA J (RD, CDE)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:J
Last Name:SUTAY
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 527
Mailing Address - Street 2:25500 POINT LOOKOUT ROAD
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-0587
Mailing Address - Country:US
Mailing Address - Phone:301-475-6185
Mailing Address - Fax:301-475-6143
Practice Address - Street 1:25500 POINT LOOKOUT ROAD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-0587
Practice Address - Country:US
Practice Address - Phone:301-475-6185
Practice Address - Fax:301-475-6143
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDO 0679133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered