MEDICARE: MISS STEPHANIE G WADE MPH, RD

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	ND 4558	FL

General Provider Information

NPI Number	:	1285865147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS STEPHANIE G WADE MPH, RD

Provider Business Mailing Address
First Line	:	3114 COMMERCE PARKWAY
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-3943
Country	:	US
Telephone Number	:	305-816-5800
Fax Number	:	305-816-5844

Provider Business Practice Location Address
First Line	:	3114 COMMERCE PARKWAY
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-3943
Country	:	US
Telephone Number	:	305-816-5800
Fax Number	:	305-816-5844

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

Provider Enumeration Date	:	07/27/2009
Last Update Date	:	07/27/2009

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