Provider Demographics
NPI:1841673167
Name:CASILLAS, STEFANIE (MS, RDN, CNSC)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:CASILLAS
Suffix:
Gender:F
Credentials:MS, RDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 3RD AVE
Mailing Address - Street 2:APT 7K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:171 E 2ND ST
Practice Address - Street 2:APT 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-8063
Practice Address - Country:US
Practice Address - Phone:917-853-3015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1066577133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered