Provider Demographics
NPI:1043530306
Name:CANFIELD, STACEY MARIE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:MARIE
Last Name:CANFIELD
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 1:300 PINE STREET
Mailing Address - Street 2:REAR
Mailing Address - City:TAYLOR
Mailing Address - State:PA
Mailing Address - Zip Code:18517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 PINE ST
Practice Address - Street 2:REAR
Practice Address - City:TAYLOR
Practice Address - State:PA
Practice Address - Zip Code:18517-1122
Practice Address - Country:US
Practice Address - Phone:570-677-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004249133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered