Provider Demographics
NPI:1518304740
Name:SCHUBERT, ANITA (MS)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:SCHUBERT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4441
Mailing Address - Country:US
Mailing Address - Phone:860-432-3131
Mailing Address - Fax:
Practice Address - Street 1:8 HEBRON RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1272
Practice Address - Country:US
Practice Address - Phone:860-467-6518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001160133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist