Mackenzie Erin Sullivan, MS,RDN, LDN, CDE

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DN005869 Issued in PA

Practice address

317 W Lockhart St
Sayre, PA 18840-1618

Phone

(570) 887-3920

Fax

(570) 887-3035

NPI assigned

Apr 13, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1460505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1801250147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-888-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 W LOCKHART ST",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401618",
            "telephone_number": "570-887-3920",
            "fax_number": "570-887-3035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MACKENZIE",
        "middle_name": "ERIN",
        "credential": "MS,RDN, LDN, CDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-13",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN005869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sullivanmack@direct-guthrie.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "317 W Lockhart St",
            "city": "Sayre",
            "state": "PA",
            "country_code": "US",
            "postal_code": "188401618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Paul Adrien Suarez, MD
• Abdul Subhan, MD
• Rashmi Subramani
• Manuel Anthony Sucuzhanay, PHARMD
• Chalairat Suk-Ouichai, MD, MPH
• Abdullah Sultany, MD
• Mohammad Sulaiman Sultany, M.D
• Meghan Sutryk
• Stacey Ann Swanson, PA-C
• Mohammad Taha Syed, M.D

• Registered Dietitian in Sayre, PA
• Providers in Sayre, PA by specialty
• Registered Dietitian in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; 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.