Healthcare Provider Details

I. General information

NPI: 1861769531
Provider Name (Legal Business Name): MICHELLE J STEWART MPH, RD, LD, N, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2011
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SATINLEAF ST
HOLLYWOOD FL
33019-4815
US

IV. Provider business mailing address

1050 SATINLEAF ST
HOLLYWOOD FL
33019-4815
US

V. Phone/Fax

Practice location:
  • Phone: 954-927-9062
  • Fax: 877-647-0535
Mailing address:
  • Phone: 954-927-9062
  • Fax: 954-927-9048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND 4295
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: