Provider Demographics
NPI:1407235245
Name:SANCHEZ, STACEY (NUTRITION THERAPIST)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:NUTRITION THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 CLIPPERT ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-2731
Mailing Address - Country:US
Mailing Address - Phone:313-299-9800
Mailing Address - Fax:
Practice Address - Street 1:3998 CLIPPERT ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HTS
Practice Address - State:MI
Practice Address - Zip Code:48125-2731
Practice Address - Country:US
Practice Address - Phone:313-299-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist