MEDICARE: MS. DEANNA BUSTEED MS, RD, CSSD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	NU 1814	MA

General Provider Information

NPI Number	:	1457612301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEANNA BUSTEED MS, RD, CSSD, LD

Provider Business Mailing Address
First Line	:	1205 ROSS DR SW
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-6723
Country	:	US
Telephone Number	:	617-835-2351
Fax Number	:

Provider Business Practice Location Address
First Line	:	5980 9TH ST # 1259
Second Line	:
City	:	FORT BELVOIR
State	:	VA
Zip	:	22060-5509
Country	:	US
Telephone Number	:	571-231-1210
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	12/12/2023

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