Provider Demographics
NPI:1801689484
Name:UNDERWOOD, ERICA SUSAN (MS, RD, CLC, CDN)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:SUSAN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MS, RD, CLC, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-3222
Mailing Address - Country:US
Mailing Address - Phone:518-534-5770
Mailing Address - Fax:
Practice Address - Street 1:125 WOLF RD STE 212
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1221
Practice Address - Country:US
Practice Address - Phone:518-417-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008976-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered