Provider Demographics
NPI:1942899661
Name:GRASSO, STEPHANIE MARIE (RD, MS)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:GRASSO
Suffix:
Gender:F
Credentials:RD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12165 BRECKNOCK ST
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2348
Mailing Address - Country:US
Mailing Address - Phone:703-463-8592
Mailing Address - Fax:
Practice Address - Street 1:12165 BRECKNOCK ST
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-2348
Practice Address - Country:US
Practice Address - Phone:703-463-8592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered