Healthcare Provider Details

I. General information

NPI: 1447866926
Provider Name (Legal Business Name): RITA ANN EUSANIO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2020
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6354 WALKER LN
ALEXANDRIA VA
22310-3229
US

IV. Provider business mailing address

6354 WALKER LN
ALEXANDRIA VA
22310-3229
US

V. Phone/Fax

Practice location:
  • Phone: 703-608-5808
  • Fax:
Mailing address:
  • Phone: 703-608-8508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX4800
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: