Provider Demographics
NPI:1629133145
Name:FISHER, STACY L (RD, LD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:FISHER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:RAPTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:2601 STIRLING CIR UNIT 411
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-7070
Mailing Address - Country:US
Mailing Address - Phone:425-324-1439
Mailing Address - Fax:
Practice Address - Street 1:2601 STIRLING CIR UNIT 411
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-7070
Practice Address - Country:US
Practice Address - Phone:425-324-1439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMT03021Medicare ID - Type Unspecified