Provider Demographics
NPI:1407030943
Name:ADAMS, STACEY LYNN (MPH, RD, CDN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MPH, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504-506 EAST 74TH STREET
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-249-4061
Mailing Address - Fax:212-249-4659
Practice Address - Street 1:505 EAST 70TH STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-746-1578
Practice Address - Fax:212-746-8483
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005241133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal