Active NPI
Susan Edith Travis, PH.D.
- Registered Dietitian
- Ithaca, NY
National Provider Identifier
1649427261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 001553
- Practice address
- 202 E State St
Suite 402
Ithaca, NY 14850-5551 - Phone
- (607) 275-0224
- Fax
- (607) 275-0224
- NPI assigned
- Aug 26, 2008
- 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 | 001553 | NY | Primary |
Addresses
Primary practice location
202 E State St
Suite 402
Ithaca, NY 14850-5551
Mailing address
202 E State St
Suite 402
Ithaca, NY 14850-5551
Phone (607) 275-0224
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001553 | Other | NY | NEW YORK STATE CERTIFICATION |
| 718865 | Other | NY | AMERICAN DIETETIC ASSOCIATION |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001553 | NY | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219708800000",
"number": "1649427261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 E STATE ST",
"address_2": "SUITE 402",
"city": "ITHACA",
"state": "NY",
"postal_code": "148505551",
"telephone_number": "607-275-0224",
"fax_number": "607-275-0224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 E STATE ST",
"address_2": "SUITE 402",
"city": "ITHACA",
"state": "NY",
"postal_code": "148505551",
"telephone_number": "607-275-0224",
"fax_number": "607-275-0224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAVIS",
"first_name": "SUSAN",
"middle_name": "EDITH",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-26",
"last_updated": "2008-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "001553",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK STATE CERTIFICATION",
"identifier": "001553",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN DIETETIC ASSOCIATION",
"identifier": "718865",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ithaca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.