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General NPI Number Information
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NPI Number | 1154016764
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Entity Type | Individual
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Provider Name | ANASTASIA MARIA STERGOS RD, CDN
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Gender | Female
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 25 NEWELL RD
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City | BRISTOL
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State | CT
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Zip | 06010-5100
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Country | US
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Telephone | 860-845-8367
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Fax |
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Provider Business Mailing Address
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Address Line | 12 WHITEFENCE HOLW
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City | BURLINGTON
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State | CT
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Zip | 06013-2443
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Country | US
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Telephone | 860-751-4448
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number | 2289
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2289
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License Number State | CT
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