Active NPI
Susan Colavito, MS, RD, LDN
- Registered Dietitian
- East Bangor, PA
National Provider Identifier
1528186129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DN005415
- Practice address
- 327 Chestnut St
East Bangor, PA 18013-2224 - Phone
- (610) 248-6644
- NPI assigned
- Mar 26, 2007
- Last updated
- Dec 17, 2015
- 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 | DN005415 | PA | Primary |
Addresses
Primary practice location
327 Chestnut St
East Bangor, PA 18013-2224
Mailing address
327 Chestnut St
East Bangor, PA 18013-2224
Phone (610) 248-6644
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN005415 | PA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Apple a Day Nutrition Services LLC | Dietitian, Registered | Past | Accepting new patients |
| Marjorie Nolan Cohn LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Registered Dietitian
- East Bangor, PA
- NPI 1639534258
Dietitian, Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450310400000",
"number": "1528186129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "327 CHESTNUT ST",
"city": "EAST BANGOR",
"state": "PA",
"postal_code": "180132224",
"telephone_number": "610-248-6644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "327 CHESTNUT ST",
"city": "EAST BANGOR",
"state": "PA",
"postal_code": "180132224",
"telephone_number": "610-248-6644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLAVITO",
"first_name": "SUSAN",
"name_prefix": "Ms.",
"credential": "MS, RD, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-26",
"last_updated": "2015-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "PA",
"license": "DN005415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Bangor, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.