Provider Demographics
NPI:1033539291
Name:SPADARO, STACY (RD, LDN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SPADARO
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11565 PERRY HWY
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8799
Mailing Address - Country:US
Mailing Address - Phone:412-852-3165
Mailing Address - Fax:
Practice Address - Street 1:11565 PERRY HWY
Practice Address - Street 2:SUITE 1B
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8799
Practice Address - Country:US
Practice Address - Phone:412-852-3165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005206133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic