Provider Demographics
NPI:1710570478
Name:STASSI, TRACEY (MHSC, RD, LDN)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:STASSI
Suffix:
Gender:F
Credentials:MHSC, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 SPANISH BAY DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-7053
Mailing Address - Country:US
Mailing Address - Phone:215-896-0174
Mailing Address - Fax:
Practice Address - Street 1:7020 SPANISH BAY DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-7053
Practice Address - Country:US
Practice Address - Phone:215-896-0174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005446133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered