Provider Demographics
NPI:1023996444
Name:VAN DOREN, MICHELLE SURI (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SURI
Last Name:VAN DOREN
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GREENWOOD FARMS CT
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22923-2650
Mailing Address - Country:US
Mailing Address - Phone:434-760-5433
Mailing Address - Fax:
Practice Address - Street 1:301 GREENWOOD FARMS COURT
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22923-2650
Practice Address - Country:US
Practice Address - Phone:434-760-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered