Provider Demographics
NPI:1508584715
Name:FITZHENRY, STEPHANIE ROSE (RDN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ROSE
Last Name:FITZHENRY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ROSE
Other - Last Name:KOWALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:785 CINNAMINSON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1511
Mailing Address - Country:US
Mailing Address - Phone:215-586-0363
Mailing Address - Fax:
Practice Address - Street 1:120 VALLEY GREEN LN
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2079
Practice Address - Country:US
Practice Address - Phone:484-324-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006480133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered