Provider Demographics
NPI:1932759669
Name:STAHL, RACHEL (MS, RD, CDN, CDCES)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:STAHL
Suffix:
Gender:F
Credentials:MS, RD, CDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LAKE DR N
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-1156
Mailing Address - Country:US
Mailing Address - Phone:914-274-0550
Mailing Address - Fax:
Practice Address - Street 1:420 E 72ND ST APT 6A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4636
Practice Address - Country:US
Practice Address - Phone:914-274-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-15
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008135133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered