Provider Demographics
NPI:1235227356
Name:STAVINOHA, TRISHA BROOKE (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:BROOKE
Last Name:STAVINOHA
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HARVARD ST # 2
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3537
Mailing Address - Country:US
Mailing Address - Phone:508-545-0358
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 42, KANSAS STREET
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760
Practice Address - Country:US
Practice Address - Phone:508-233-4305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05909133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered