Provider Demographics
NPI:1316549744
Name:MEZERHANE, STEPHANIE MARIE (RD)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:MEZERHANE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14602 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7505
Mailing Address - Country:US
Mailing Address - Phone:954-790-2101
Mailing Address - Fax:
Practice Address - Street 1:11030 N KENDALL DR STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8814
Practice Address - Country:US
Practice Address - Phone:305-994-1825
Practice Address - Fax:305-508-5519
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND10129133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist