Provider Demographics
NPI:1134620941
Name:INEMAN, STEPHANIE (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:INEMAN
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MEADOW RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44230-1636
Mailing Address - Country:US
Mailing Address - Phone:330-933-9522
Mailing Address - Fax:
Practice Address - Street 1:70 E LAKE ST STE 226
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7650
Practice Address - Country:US
Practice Address - Phone:866-710-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6731133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered