Provider Demographics
NPI:1366338063
Name:ELIZONDO, SUZANNE (RDN, NBC-HWC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:RDN, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 HILLVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7060
Mailing Address - Country:US
Mailing Address - Phone:310-936-7304
Mailing Address - Fax:
Practice Address - Street 1:149 HILLVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7060
Practice Address - Country:US
Practice Address - Phone:310-936-7304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-3294700171400000X
CA896055133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty