Provider Demographics
NPI:1700080215
Name:WOODS, STEPHANIE J (RD,LD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:WOODS
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 ROBIN HOOD DR
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-4478
Mailing Address - Country:US
Mailing Address - Phone:321-720-3601
Mailing Address - Fax:321-639-7020
Practice Address - Street 1:2401 ROBIN HOOD DR
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-4478
Practice Address - Country:US
Practice Address - Phone:321-720-3601
Practice Address - Fax:321-639-7020
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 3741133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered