Provider Demographics
NPI:1083413512
Name:STAVINOHA, LAURA M (RD)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:M
Last Name:STAVINOHA
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 RED FERN CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-6558
Mailing Address - Country:US
Mailing Address - Phone:804-437-0127
Mailing Address - Fax:
Practice Address - Street 1:5055 RED FERN CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-6558
Practice Address - Country:US
Practice Address - Phone:804-437-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86131552133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered