Provider Demographics
NPI:1740773605
Name:EDWARDS, STEPHANIE (MS, RD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:EDWARDS
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 1:2 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1680
Mailing Address - Country:US
Mailing Address - Phone:508-298-9420
Mailing Address - Fax:
Practice Address - Street 1:2 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1680
Practice Address - Country:US
Practice Address - Phone:508-298-9420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered