Provider Demographics
NPI:1992592414
Name:STAVISS, REUBY PHILICE (RD)
Entity type:Individual
Prefix:
First Name:REUBY
Middle Name:PHILICE
Last Name:STAVISS
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 1:182 E 95TH ST APT 21A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0207
Mailing Address - Country:US
Mailing Address - Phone:857-352-2161
Mailing Address - Fax:
Practice Address - Street 1:115 NORWOOD PARK S STE 110
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4633
Practice Address - Country:US
Practice Address - Phone:857-352-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered