Provider Demographics
NPI:1629398052
Name:STASKO, RENEE A (RD LDN)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:A
Last Name:STASKO
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-2334
Mailing Address - Country:US
Mailing Address - Phone:412-364-3305
Mailing Address - Fax:
Practice Address - Street 1:128 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-2334
Practice Address - Country:US
Practice Address - Phone:412-364-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002185133V00000X
MDD01181133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered