Provider Demographics
NPI:1134846553
Name:STANLEY, KATLIN PAIGE (RDN, LD)
Entity type:Individual
Prefix:
First Name:KATLIN
Middle Name:PAIGE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 SW 174TH ST APT 345
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5661
Mailing Address - Country:US
Mailing Address - Phone:817-584-7877
Mailing Address - Fax:
Practice Address - Street 1:9500 SW 174TH ST APT 345
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5661
Practice Address - Country:US
Practice Address - Phone:817-584-7877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86150071133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered