Provider Demographics
NPI:1023999299
Name:THIELL, SUSAN (MS, RD, LDN, CNSC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:THIELL
Suffix:
Gender:F
Credentials:MS, RD, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4220
Mailing Address - Country:US
Mailing Address - Phone:508-650-2718
Mailing Address - Fax:
Practice Address - Street 1:15 HUDSON ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4220
Practice Address - Country:US
Practice Address - Phone:508-650-2718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN6071133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered