Healthcare Provider Details

I. General information

NPI: 1497625271
Provider Name (Legal Business Name): CAMERON STEPHAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RYANS RUN CT
GREENVILLE SC
29615-6056
US

IV. Provider business mailing address

300 RYANS RUN CT
GREENVILLE SC
29615-6056
US

V. Phone/Fax

Practice location:
  • Phone: 518-593-3780
  • Fax:
Mailing address:
  • Phone: 518-593-3780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number3427
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: