Provider Demographics
NPI:1841771383
Name:SMITH, STEPHANIE M (RD, LDN, CDN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD, LDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 HILLVIEW RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-9146
Mailing Address - Country:US
Mailing Address - Phone:845-863-5632
Mailing Address - Fax:
Practice Address - Street 1:366 DORSET ST STE 10
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-4479
Practice Address - Country:US
Practice Address - Phone:802-999-9207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074.0134144133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty