Provider Demographics
NPI:1023211802
Name:STASOLLA, DENISE (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:STASOLLA
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1724
Mailing Address - Country:US
Mailing Address - Phone:914-769-2270
Mailing Address - Fax:914-769-7733
Practice Address - Street 1:287 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1724
Practice Address - Country:US
Practice Address - Phone:914-769-2270
Practice Address - Fax:914-769-7733
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000144-1133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered