Provider Demographics
NPI:1831505650
Name:BASTA, AISLYNN SAGE (RD)
Entity type:Individual
Prefix:
First Name:AISLYNN
Middle Name:SAGE
Last Name:BASTA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:AISLYNN
Other - Middle Name:SAGE
Other - Last Name:PACCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-4219
Practice Address - Country:US
Practice Address - Phone:570-271-6468
Practice Address - Fax:570-271-7805
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA133V00000X
PADN005417133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered