Provider Demographics
NPI:1063682854
Name:ANASTASIA, AUDREY L (DRPH, RD, FAND)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:L
Last Name:ANASTASIA
Suffix:
Gender:F
Credentials:DRPH, RD, FAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-0641
Mailing Address - Country:US
Mailing Address - Phone:603-216-5047
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:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH188133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered