Provider Demographics
NPI:1225425457
Name:VIROSTKO, ELAINA SUZANNE (RDN)
Entity Type:Individual
Prefix:
First Name:ELAINA
Middle Name:SUZANNE
Last Name:VIROSTKO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:ELAINA
Other - Middle Name:SUZANNE
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:9300 DEWITT LOOP
Mailing Address - Street 2:O3.206D
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5285
Mailing Address - Country:US
Mailing Address - Phone:571-231-4545
Mailing Address - Fax:
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:O3.206D
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:571-231-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO964559133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered