MEDICARE: STEPHANIE L DARBY RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DT84384	TX

General Provider Information

NPI Number	:	1215484217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE L DARBY RD, LD

Provider Business Mailing Address
First Line	:	7716 TOVAR DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78729-8019
Country	:	US
Telephone Number	:	214-934-0018
Fax Number	:

Provider Business Practice Location Address
First Line	:	7716 TOVAR DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78729-8019
Country	:	US
Telephone Number	:	512-910-5515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	09/07/2016

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