Provider Demographics
NPI:1972267904
Name:GAVRILETS, ANASTASIA A (MA, RD)
Entity type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:A
Last Name:GAVRILETS
Suffix:
Gender:F
Credentials:MA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 STATE ST APT A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-1511
Mailing Address - Country:US
Mailing Address - Phone:865-308-9325
Mailing Address - Fax:
Practice Address - Street 1:142 STATE ST APT A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1511
Practice Address - Country:US
Practice Address - Phone:865-308-9325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1004X, 132700000X
NV40186-DI-0133V00000X
NV133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education