Provider Demographics
NPI:1992890776
Name:BAYDER, SUZANNE SHANA (RD LD/N)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:SHANA
Last Name:BAYDER
Suffix:
Gender:F
Credentials:RD LD/N
Other - Prefix:MS
Other - First Name:SHANA
Other - Middle Name:
Other - Last Name:BAYDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD LD/N
Mailing Address - Street 1:21 SOUTHERN CROSS CIRCLE # 105
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436
Mailing Address - Country:US
Mailing Address - Phone:561-681-2524
Mailing Address - Fax:561-681-2501
Practice Address - Street 1:1665 PALM BEACH LAKES BLVD SUITE B-900
Practice Address - Street 2:PALM BEACH COUNTYHEALTH DEPT.
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-681-2524
Practice Address - Fax:561-681-2501
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3163133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist