Provider Demographics
NPI:1134753155
Name:AUDREY L. ANASTASIA, DRPH, RD, LLC
Entity type:Organization
Organization Name:AUDREY L. ANASTASIA, DRPH, RD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANASTASIA
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH, RD
Authorized Official - Phone:603-533-4937
Mailing Address - Street 1:70 MAIN ST UNIT 200
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-2467
Mailing Address - Country:US
Mailing Address - Phone:603-924-7797
Mailing Address - Fax:
Practice Address - Street 1:150 TARRYTOWN RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2713
Practice Address - Country:US
Practice Address - Phone:603-622-3162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty