Provider Demographics
NPI:1346652898
Name:RODRIGUEZ, STEPHANY (MS, RD, LD/N)
Entity type:Individual
Prefix:
First Name:STEPHANY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2886 SW 127TH WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4122
Mailing Address - Country:US
Mailing Address - Phone:786-282-4693
Mailing Address - Fax:
Practice Address - Street 1:2886 SW 127TH WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4122
Practice Address - Country:US
Practice Address - Phone:786-282-4693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6528133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered