Provider Demographics
NPI:1740450139
Name:BALL, STEPHANIE LEE-ANNE (RD)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LEE-ANNE
Last Name:BALL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 N MIAMI AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-2848
Mailing Address - Country:US
Mailing Address - Phone:866-595-6505
Mailing Address - Fax:
Practice Address - Street 1:452 CODY AVE
Practice Address - Street 2:BLD 90232
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544-5417
Practice Address - Country:US
Practice Address - Phone:850-884-3438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5309133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered