Healthcare Provider Details

I. General information

NPI: 1154016764
Provider Name (Legal Business Name): ANASTASIA MARIA STERGOS RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NEWELL RD
BRISTOL CT
06010-5100
US

IV. Provider business mailing address

12 WHITEFENCE HOLW
BURLINGTON CT
06013-2443
US

V. Phone/Fax

Practice location:
  • Phone: 860-845-8367
  • Fax:
Mailing address:
  • Phone: 860-751-4448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number2289
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2289
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: