Healthcare Provider Details

I. General information

NPI: 1134753155
Provider Name (Legal Business Name): AUDREY L. ANASTASIA, DRPH, RD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 TARRYTOWN RD
MANCHESTER NH
03103-2713
US

IV. Provider business mailing address

70 MAIN ST UNIT 200
PETERBOROUGH NH
03458-2467
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-3162
  • Fax:
Mailing address:
  • Phone: 603-924-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: AUDREY L ANASTASIA
Title or Position: MEMBER
Credential: DRPH, RD
Phone: 603-533-4937