Susan Banuelos Smith, MS RD LD CDE

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DT05851 Issued in TX

Practice address

5308 N Galloway Ave Ste 200
Mesquite, TX 75150-1125

Phone

(214) 358-2300

Fax

(214) 579-6754

NPI assigned

May 29, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Susan Banuelos Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

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.

• Dcoa Physicians PA

  • Medical Specialty Clinic/Center
  • Katy, TX
  • NPI 1023228699
  NPD (past)

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

{
    "created_epoch": "1527552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663891200000",
    "number": "1407347297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "447 LAKEDALE DR",
            "city": "MURPHY",
            "state": "TX",
            "postal_code": "750944289",
            "telephone_number": "469-734-0822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5308 N GALLOWAY AVE STE 200",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751501125",
            "telephone_number": "214-358-2300",
            "fax_number": "214-579-6754"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8515 Greenville Ave Ste N108",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752437035",
            "country_code": "US",
            "telephone_number": "214-221-0855",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SUSAN",
        "middle_name": "BANUELOS",
        "credential": "MS RD LD CDE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-29",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT05851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED DIETITIAN",
            "identifier": "DT05851",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "BANUELOS",
            "credential": "RD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kenchelle S Smith
• Khandice Chantee Smith
• Ronald K Smith, O.D.
• Sara Bonita Smith
• Susan Allen Smith
• Snappy Lab Services
• Snoring and Sleep Apnea Wellness Center, LLC
• Jason Emmons Snyder, RPH
• Terry M Sobey, MD
• Soh of Texas Samson Liu PLLC

• Registered Dietitian in Mesquite, TX
• Providers in Mesquite, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; 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.