Provider Demographics
NPI:1205384864
Name:STEFIN, JENNA (MS, RD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:STEFIN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SUMMER ST
Mailing Address - Street 2:APT 709
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3926
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 SUMMER ST
Practice Address - Street 2:APT 709
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3926
Practice Address - Country:US
Practice Address - Phone:954-695-7672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4148133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered