Provider Demographics
NPI:1003149311
Name:KUCEL, STASHA (RD)
Entity Type:Individual
Prefix:
First Name:STASHA
Middle Name:
Last Name:KUCEL
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 1:920 WHISTLER LN
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8672
Mailing Address - Country:US
Mailing Address - Phone:214-326-2158
Mailing Address - Fax:
Practice Address - Street 1:920 WHISTLER LN
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8672
Practice Address - Country:US
Practice Address - Phone:214-326-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81272133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered