Healthcare Provider Details

I. General information

NPI: 1972267904
Provider Name (Legal Business Name): ANASTASIA A GAVRILETS MA, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 STATE ST APT A
RENO NV
89501-1511
US

IV. Provider business mailing address

142 STATE ST APT A
RENO NV
89501-1511
US

V. Phone/Fax

Practice location:
  • Phone: 865-308-9325
  • Fax:
Mailing address:
  • Phone: 865-308-9325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number40186-DI-0
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: