Provider Demographics
NPI:1831634930
Name:STERNBERG, TAVA (RD)
Entity Type:Individual
Prefix:
First Name:TAVA
Middle Name:
Last Name:STERNBERG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 E INDIA ROW
Mailing Address - Street 2:APT 40H
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-3320
Mailing Address - Country:US
Mailing Address - Phone:802-345-1881
Mailing Address - Fax:
Practice Address - Street 1:85 E INDIA ROW
Practice Address - Street 2:APT 40H
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-3320
Practice Address - Country:US
Practice Address - Phone:802-345-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4031133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered