Healthcare Provider Details

I. General information

NPI: 1427891357
Provider Name (Legal Business Name): STEPHANIE M ROHALEY RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3999 RICHMOND RD
BEACHWOOD OH
44122-6046
US

IV. Provider business mailing address

8334 FAIRFAX DR
MENTOR OH
44060-3838
US

V. Phone/Fax

Practice location:
  • Phone: 216-593-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberLD.7288
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: