Healthcare Provider Details

I. General information

NPI: 1104564327
Provider Name (Legal Business Name): THE EUSANIO GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 KING CENTRE DR STE 600
ALEXANDRIA VA
22315-5755
US

IV. Provider business mailing address

5903 MOUNT EAGLE DR APT 1409
ALEXANDRIA VA
22303-2532
US

V. Phone/Fax

Practice location:
  • Phone: 703-608-5808
  • Fax: 703-263-8650
Mailing address:
  • Phone: 703-608-5808
  • Fax: 703-263-8650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: RITA ANN EUSANIO
Title or Position: REGISTERED DIETITIAN
Credential:
Phone: 703-608-5808