Provider Demographics
NPI:1629340831
Name:O'NEILL, STEPHANIE (MS RD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MS RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 E MAIN ST
Mailing Address - Street 2:APARTMENT 201
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-2421
Mailing Address - Country:US
Mailing Address - Phone:401-523-3513
Mailing Address - Fax:
Practice Address - Street 1:49 E MAIN ST
Practice Address - Street 2:APARTMENT 201
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-2421
Practice Address - Country:US
Practice Address - Phone:401-523-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered