MEDICARE: JENNIFER MARIE STERVINOU R.D., L.D.

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	DT80795	TX

General Provider Information

NPI Number	:	1649426263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE STERVINOU R.D., L.D.

Provider Business Mailing Address
First Line	:	1730 ASCENSION POINT DR
Second Line	:	UNIT #223
City	:	ARLINGTON
State	:	TX
Zip	:	76006-4286
Country	:	US
Telephone Number	:	210-218-3520
Fax Number	:

Provider Business Practice Location Address
First Line	:	3330 KELLER SPRINGS RD
Second Line	:	SUITE 205
City	:	CARROLLTON
State	:	TX
Zip	:	75006-5058
Country	:	US
Telephone Number	:	972-238-7200
Fax Number	:

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

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	08/14/2008

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