Healthcare Provider Details

I. General information

NPI: 1396057048
Provider Name (Legal Business Name): STEPHANIE ALLEN R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 07/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721D SUNSET BLVD
LEXINGTON SC
29072-9151
US

IV. Provider business mailing address

4721D SUNSET BLVD
LEXINGTON SC
29072-9151
US

V. Phone/Fax

Practice location:
  • Phone: 803-996-0312
  • Fax: 803-957-2496
Mailing address:
  • Phone: 803-996-0312
  • Fax: 803-957-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number645
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: