Healthcare Provider Details

I. General information

NPI: 1154954220
Provider Name (Legal Business Name): ANASTASIYA KHABIROVA RD, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 85TH ST
NEW YORK NY
10028-3001
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL # 1118
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number010192
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number010192
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number010192
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: