Susan K Phillip, NDTR

Primary specialty

Registered Dietetic TechnicianTaxonomy code 136A00000X

License

1018812

Practice address

67 Glendale St
Dorchester, MA 02125-2404

Phone

(617) 233-4950

NPI assigned

Jan 29, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552867200000",
    "number": "1225592736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 GLENDALE ST",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021252404",
            "telephone_number": "617-233-4950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 GLENDALE ST",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021252404",
            "telephone_number": "617-233-4950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIP",
        "first_name": "SUSAN",
        "middle_name": "K",
        "name_prefix": "Ms.",
        "credential": "NDTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-29",
        "last_updated": "2019-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "136A00000X",
            "taxonomy_group": "",
            "desc": "Dietetic Technician, Registered",
            "state": null,
            "license": "1018812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanya Pham
• An T Phan, M.D.
• Lan-Thuy Phan
• Nuong Ai Phan, LIC.AC.
• Edna Phifer, RN, BSN
• Sarah Christiane Phillips, MD
• Rhonda Phung
• Roselyn F Pichardo
• Meghan Pickell
• Javier Piedad, DS

• Registered Dietetic Technician in Dorchester, MA
• Providers in Dorchester, MA by specialty
• Registered Dietetic Technician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.