Victoria Rose Banaczuk, MS, RD, LDN
Individual provider Active NPI Registered Dietitian · Providence, RI
NPI 1831066828 · NPPES record last updated Dec 1, 2025
Key facts
- NPI
- 1831066828
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- LDN01611 (RI)
- Practice address
- 593 Eddy St
Providence, RI 02903-4923 - Phone
- (401) 444-5603
- NPI assigned
- Oct 22, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 2024
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
15 La Salle SQ
Providence, RI 02903-1814
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in RI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251211001027 | RI | Practitioner - Registered Dietitian Or Nutrition Professional | 6103310735 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LDN01611 | RI | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rhode Island Hospital | Dietitian, Registered | Current |
Accepting new patients |
| Rhode Island Hospital | Current |
Accepting new patients | |
| Rhode Island Hospital | Past | Accepting new patients |
Locations
15 La Salle Sq
Providence, RI 02903
593 Eddy St
Providence, RI 02903
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | LDN01611 | RI | Yes |
Addresses
Primary practice location
593 Eddy St
Providence, RI 02903-4923
Mailing address
15 La Salle SQ
Providence, RI 02903-1814
Phone (401) 444-6779
Other providers in Providence, RI
- Sujata Balgobin
- Audrey Ballard
- Samantha Ballas
- Ashley Balon
- Antra Bami
- Christina Bandera
- Mason C. Bandy
- Surjo Bandyopadhyay
- Debasree Banerjee
- Debolina Banerjee
All providers in Providence, RI · Registered Dietitian in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.