Active NPI
Christie L Suders, REGISTERED DIETITIAN
- Registered Dietitian
- Penfield, NY
National Provider Identifier
1023848439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 893926
- Practice address
- 15 Shady Rock Rd
Penfield, NY 14526-9000 - Phone
- (585) 729-6565
- NPI assigned
- Aug 2, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 893926 | NY | Primary |
Addresses
Primary practice location
15 Shady Rock Rd
Penfield, NY 14526-9000
Mailing address
15 Shady Rock Rd
Penfield, NY 14526-9000
Phone (585) 729-6565
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 893926 | NY | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722556800000",
"number": "1023848439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 SHADY ROCK RD",
"city": "PENFIELD",
"state": "NY",
"postal_code": "145269000",
"telephone_number": "585-729-6565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 SHADY ROCK RD",
"city": "PENFIELD",
"state": "NY",
"postal_code": "145269000",
"telephone_number": "585-729-6565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUDERS",
"first_name": "CHRISTIE",
"middle_name": "L",
"credential": "REGISTERED DIETITIAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-08-02",
"last_updated": "2024-08-02",
"certification_date": "2024-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "893926",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Penfield, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.