Healthcare Provider Details

I. General information

NPI: 1124408869
Provider Name (Legal Business Name): WENDY STEPHENS RD/LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 4TH ST N
ST PETERSBURG FL
33702-4305
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 407-225-3259
  • Fax:
Mailing address:
  • Phone: 407-225-3259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND5791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: