Provider Demographics
NPI:1659015535
Name:BYERS, STEPHANIE REEVES (MS, RDN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:REEVES
Last Name:BYERS
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E. RIDGEWOOD AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-956-3403
Mailing Address - Fax:
Practice Address - Street 1:245 E. RIDGEWOOD AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-956-3403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL879744133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered