Provider Demographics
NPI:1396393757
Name:KASIANCHUK, ANASTASIA (MS, RD, LD, CSSD)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:KASIANCHUK
Suffix:
Gender:F
Credentials:MS, RD, LD, CSSD
Other - Prefix:
Other - First Name:STASI
Other - Middle Name:
Other - Last Name:KASIANCHUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, LD, CSSD
Mailing Address - Street 1:2955 NW MONTEREY DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3434
Mailing Address - Country:US
Mailing Address - Phone:541-619-1437
Mailing Address - Fax:
Practice Address - Street 1:2955 NW MONTEREY DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3434
Practice Address - Country:US
Practice Address - Phone:541-257-5091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10164889133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty