Provider Demographics
NPI:1518776939
Name:ROBERTSON, ROSALYN MASI (RD)
Entity type:Individual
Prefix:
First Name:ROSALYN
Middle Name:MASI
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 MERRIMAC DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-2309
Mailing Address - Country:US
Mailing Address - Phone:540-419-3025
Mailing Address - Fax:
Practice Address - Street 1:2012 MERRIMAC DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-2309
Practice Address - Country:US
Practice Address - Phone:540-419-3025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered