Provider Demographics
NPI:1447718895
Name:PANTSCHENKO, KIRA (DTR)
Entity type:Individual
Prefix:MS
First Name:KIRA
Middle Name:
Last Name:PANTSCHENKO
Suffix:
Gender:F
Credentials:DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DEEPWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-1317
Mailing Address - Country:US
Mailing Address - Phone:203-442-6027
Mailing Address - Fax:
Practice Address - Street 1:7 DEEPWOOD LN
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-1317
Practice Address - Country:US
Practice Address - Phone:860-559-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered