Provider Demographics
NPI:1992020705
Name:MEESE-MORRIS, SUSAN MARIE (RD, CSR, LDN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:MEESE-MORRIS
Suffix:
Gender:F
Credentials:RD, CSR, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9491 OAK GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-6939
Mailing Address - Country:US
Mailing Address - Phone:954-205-5462
Mailing Address - Fax:
Practice Address - Street 1:333 NW 70TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2358
Practice Address - Country:US
Practice Address - Phone:954-581-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3293133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal