Provider Demographics
NPI:1487533725
Name:PEREZ, STEPHANIE A (RDN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N CHEW RD
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-3102
Mailing Address - Country:US
Mailing Address - Phone:609-892-8563
Mailing Address - Fax:
Practice Address - Street 1:414 N CHEW RD
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-3102
Practice Address - Country:US
Practice Address - Phone:609-892-8563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-30
Last Update Date:2025-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist