Individual
DR. SUSAN EDITH TRAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
202 E STATE ST, SUITE 402, ITHACA, NY 14850-5551
(607) 275-0224
(607) 275-0224
Mailing address
202 E STATE ST, SUITE 402, ITHACA, NY 14850-5551
(607) 275-0224
(607) 275-0224
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
001553
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001553
NEW YORK STATE CERTIFICATION
NY
01
—
718865
AMERICAN DIETETIC ASSOCIATION
NY
Enumeration date
08/26/2008
Last updated
08/26/2008
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