Provider Demographics
NPI:1932926003
Name:WASILAUSKY, CRYSTAL NICOLE (MS)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:NICOLE
Last Name:WASILAUSKY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21826 ENGLESIDE PL
Mailing Address - Street 2:
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4542
Mailing Address - Country:US
Mailing Address - Phone:571-208-7973
Mailing Address - Fax:
Practice Address - Street 1:21826 ENGLESIDE PL
Practice Address - Street 2:
Practice Address - City:BROADLANDS
Practice Address - State:VA
Practice Address - Zip Code:20148-4542
Practice Address - Country:US
Practice Address - Phone:571-208-7973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist