Provider Demographics
NPI:1568099471
Name:VENERO, STEPHANY (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:
Last Name:VENERO
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:STEPHANY
Other - Middle Name:
Other - Last Name:VENERO SHIMABUKURO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTERED DIETITIAN
Mailing Address - Street 1:9206 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1716
Mailing Address - Country:US
Mailing Address - Phone:240-205-0865
Mailing Address - Fax:
Practice Address - Street 1:1221 MERCANTILE LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5374
Practice Address - Country:US
Practice Address - Phone:301-618-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000865133V00000X
MDDX3640133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered