Provider Demographics
NPI:1619144136
Name:STAHL, AMY LYNN (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:STAHL
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 BISSONNET
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3120
Mailing Address - Country:US
Mailing Address - Phone:713-838-9050
Mailing Address - Fax:713-838-9098
Practice Address - Street 1:4500 BISSONNET
Practice Address - Street 2:SUITE 340
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3120
Practice Address - Country:US
Practice Address - Phone:713-838-9050
Practice Address - Fax:713-838-9098
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT 04626133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered