Provider Demographics
NPI:1457612301
Name:BUSTEED, DEANNA (MS, RD, CSSD, LD)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:
Last Name:BUSTEED
Suffix:
Gender:F
Credentials:MS, RD, CSSD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 ROSS DR SW
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-6723
Mailing Address - Country:US
Mailing Address - Phone:617-835-2351
Mailing Address - Fax:
Practice Address - Street 1:5980 9TH ST # 1259
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5509
Practice Address - Country:US
Practice Address - Phone:571-231-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANU 1814133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered