Active NPI
Susan Sheidler Rysedorph, R.D., L.D.N.
- Registered Dietitian
- Cordova, TN
National Provider Identifier
1477762003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LDN0000000978
- Practice address
- 310 Germantown Bend CV
Suite 101
Cordova, TN 38018-4267 - Phone
- (901) 759-9337
- Fax
- (901) 759-7967
- NPI assigned
- May 21, 2007
- 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 | LDN0000000978 | TN | Primary |
Addresses
Primary practice location
310 Germantown Bend CV
Suite 101
Cordova, TN 38018-4267
Mailing address
8997 Shady Leaf CV
Cordova, TN 38018-7414
Phone (901) 759-0399
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LDN0000000978 | TN | MD | Registered Dietitian |
| 978 | TN | MD | Hearing Instrument Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dietitian Associates, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
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": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477762003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8997 SHADY LEAF CV",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380187414",
"telephone_number": "901-759-0399"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 GERMANTOWN BEND CV",
"address_2": "SUITE 101",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380184267",
"telephone_number": "901-759-9337",
"fax_number": "901-759-7967"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYSEDORPH",
"first_name": "SUSAN",
"middle_name": "SHEIDLER",
"name_prefix": "Ms.",
"credential": "R.D., L.D.N.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TN",
"license": "LDN0000000978",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cordova, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.