Provider Demographics
NPI:1679964316
Name:KYRIAKOPOULOS, ANASTASIA (RDN)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:KYRIAKOPOULOS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2428
Mailing Address - Country:US
Mailing Address - Phone:727-785-1526
Mailing Address - Fax:
Practice Address - Street 1:500 E LAKE RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-2428
Practice Address - Country:US
Practice Address - Phone:727-785-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6492133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered