Provider Demographics
NPI:1649426263
Name:STERVINOU, JENNIFER MARIE (RD, LD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:STERVINOU
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 ASCENSION POINT DR
Mailing Address - Street 2:UNIT #223
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-4286
Mailing Address - Country:US
Mailing Address - Phone:210-218-3520
Mailing Address - Fax:
Practice Address - Street 1:3330 KELLER SPRINGS RD
Practice Address - Street 2:SUITE 205
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-5058
Practice Address - Country:US
Practice Address - Phone:972-238-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80795133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered