Provider Demographics
NPI:1386953370
Name:FERRARI, STACY (MPH, RD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:FERRARI
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 SW LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-4514
Mailing Address - Country:US
Mailing Address - Phone:772-486-2016
Mailing Address - Fax:
Practice Address - Street 1:1170 SW LIGHTHOUSE DR
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-4514
Practice Address - Country:US
Practice Address - Phone:772-486-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-25
Last Update Date:2010-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ853854133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered