Healthcare Provider Details

I. General information

NPI: 1194979138
Provider Name (Legal Business Name): ANN VERONICA EFSTATHION MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST. TUFT'S MEDICAL CENTER FRANCES STERN NUTRITION CENTER
BOSTON MA
02111
US

IV. Provider business mailing address

800 WASHINGTON ST. #783 TUFT'S MEDICAL CENTER FRANCES STERN NUTRITION CENT
BOSTON MA
02111
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5273
  • Fax: 617-636-8325
Mailing address:
  • Phone: 617-636-5273
  • Fax: 617-636-8325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1480
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: