SUSAN RICARDO BUCKLEY (NPI# 1225383094) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225383094 |
| Entity Type | Individual |
| Full Name | SUSAN RICARDO BUCKLEY |
| Other Name | SUSAN R MELLA |
| Credential | ND |
| Practice Address |
1259 S Beach St Apt 1105 Daytona Beach FL 32114 |
| Mailing Address |
1259 S Beach St Apt 1105 Daytona Beach FL 32114-6328 |
| Practice Telephone | 3865279178 |
| Mailing Telephone | 3865279178 |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2019-07-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133V00000X | Dietitian, Registered | ND4064 | FL | Dietary & Nutritional Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1340 Ridgewood Ave, Holly Hill, FL 321172320 | 3866767130 | 3866767125 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841744000 | Susan Buckley | Technician, Other | 4938 Indiana Ave Ne, Salem, OR 97305-2974 | 2016-08-05 |
| 1780758516 | Susan Lynne Buckley | Physical Therapist | 4414 Stanley Ave, Downers Grove, IL 60515-2905 | 2006-11-20 |
| 1326122912 | Susan Joan Buckley | Nurse Practitioner | 938 E Zero St, Suite B, Ainsworth, NE 69210-1555 | 2006-10-24 |
| 1457872434 | Susan Buckley | Physical Therapist | 100 Fallwood Road, Redwood Area Hospital, Redwood Falls, MN 56283 | 2017-06-29 |
| 1437389970 | Susan Buckley | Student in an Organized Health Care Education/Training Program | 835 3rd Ave, Suite E, Chula Vista, CA 91911-1352 | 2009-07-17 |
| 1306016316 | Susan Ann Buckley | Occupational Therapist | 159 Indian Head Rd, Commack, NY 11725-2205 | 2008-03-05 |
| 1396925699 | Susan L Buckley | Audiologist | 1206 York Rd, Suite 201, Lutherville, MD 21093-6217 | 2007-11-05 |
| 1831213586 | Susan Douglas Buckley | Psychologist | 209 Cooper Ave, Montclair, NJ 07043-1883 | 2007-03-19 |
| 1942219951 | Susan Buckley | Dietitian, Registered | 1000 Southpark Drive, Littleton, CO 80120-5654 | 2006-08-07 |
| 1760458541 | Susan R. Buckley | Nurse Practitioner | 246 Pleasant St, Suite G2, Concord, NH 03301-7539 | 2006-02-23 |
| Street Address |
1259 S BEACH ST APT 1105 |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467005504 | Innovative Nutrition and Wellness Consulting, LLC | Dietitian, Registered | 1259 S Beach St Apt 1105, Daytona Beach, FL 32114-6328 | 2019-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376161380 | Evolution Health & Performance LLC | Physician Assistant | 244 S. Palmetto Ave, Daytona Beach, FL 32114 | 2020-07-07 |
| 1407480189 | Kierra Imani Kinsey | Behavior Technician | 1128-a Beville Rd, Daytona Beach, FL 32114 | 2020-03-02 |
| 1043776057 | Outreach Community Care Network Inc | Pharmacy | 240 N. Frederick Avenue, Daytona Beach, FL 32114 | 2019-02-14 |
| 1033681861 | Katherine Proppe | Specialist/Technologist | 1 Aerospace Blvd, Daytona Beach, FL 32114 | 2018-12-18 |
| 1841765047 | Anna L Smith | Nurse Practitioner | 339 Bill France Blvd Ste C, Daytona Beach, FL 32114 | 2018-10-04 |
| 1154806933 | Steve Anthony Lee | Family Medicine | 731 N. Clyde Morris Blvd, Daytona Beach, FL 32114 | 2018-09-27 |
| 1285116491 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1348 W International Speedway Blvd Ste 2, Daytona Beach, FL 32114 | 2018-09-04 |
| 1770085656 | Merina Lee | Occupational Therapist | 1159 Australia Ave., Daytona Beach, FL 32114 | 2018-03-06 |
| 1346752755 | Hand & Upper Extremity Surgery of Daytona Beach, LLC | Non-Pharmacy Dispensing Site | 1241 Ridgewood Ave, Daytona Beach, FL 32114 | 2017-10-26 |
| 1104347053 | Harry Herman Blanke IIi | Family Medicine | 201 N Clyde Morris Blvd, Suite 200, Halifax Health Family Medicine Residency Program, Daytona Beach, FL 32114 | 2017-06-30 |
| Find all providers in zip 32114 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811465537 | Tiffany Mcclure | Dietitian, Registered | 330 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2018-11-12 |
| 1467005504 | Innovative Nutrition and Wellness Consulting, LLC | Dietitian, Registered | 1259 S Beach St Apt 1105, Daytona Beach, FL 32114-6328 | 2019-07-18 |
| 1962854281 | Jennifer Robinson | Dietitian, Registered | 224 Memorial Medical Pkwy, Daytona Beach, FL 32117-5111 | 2016-07-11 |
| 1245696301 | Andrea Likens | Dietitian, Registered | 350 N Clyde Morris Blvd, Suite 9, Daytona Beach, FL 32114-2733 | 2016-01-05 |
| 1306239223 | Tonia Marchena | Dietitian, Registered | 1845 Holsonback Dr, Daytona Beach, FL 32117-5114 | 2015-03-17 |
| 1063719672 | Kimberly Kay Koevenig | Dietitian, Registered | 311 N Clyde Morris Blvd, Suite 440-outpatient Diabetes Education, Halifax Health, Daytona Beach, FL 32114-2781 | 2011-02-16 |
| 1487808507 | Angela Baker Sterrett | Dietitian, Registered | 301 Memorial Medical Pkwy, Daytona Beach, FL 32117-5167 | 2008-11-17 |
| 1316025125 | Mary Cynthia Liebler | Dietitian, Registered | 303 N Clyde Morris Blvd, Daytona Beach, FL 32114-2709 | 2006-11-01 |
| 1386755569 | Patricia Murray Leapley | Dietitian, Registered | 551 National Health Care Dr, Daytona Beach, FL 32114-1495 | 2006-08-31 |
| 1902831308 | Melissa E. Baumann | Dietitian, Registered | 201 N Clyde Morris Blvd, Daytona Beach, FL 32114-2724 | 2006-07-12 |
| Find all providers in DAYTONA BEACH | ||||
| City | DAYTONA BEACH |
| Zip Code | 32114 |
Please comment or provide details below to improve the information on SUSAN RICARDO BUCKLEY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.