Healthcare Provider Details

I. General information

NPI: 1275099350
Provider Name (Legal Business Name): KATELYNN MARIE STANSFIELD RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYNN MARIE PERZYNSKI RD

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 N 28TH ST STE 308
RICHMOND VA
23223-5311
US

IV. Provider business mailing address

8266 ATLEE RD STE 215
MECHANICSVILLE VA
23116-1805
US

V. Phone/Fax

Practice location:
  • Phone: 804-764-7885
  • Fax:
Mailing address:
  • Phone: 804-764-7885
  • Fax: 804-559-6185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: