Healthcare Provider Details

I. General information

NPI: 1386037547
Provider Name (Legal Business Name): STACEY WHITELOCKE L.AC, RD/LDN.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR MIAMI CANCER INSTITUTE
MIAMI FL
33176-2118
US

IV. Provider business mailing address

8900 N KENDALL DR MIAMI CANCER INSTITUTE
MIAMI FL
33176-2118
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-2000
  • Fax:
Mailing address:
  • Phone: 786-596-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 3584
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND4479
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: