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General NPI Number Information
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NPI Number | 1053539023
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Entity Type | Individual
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Provider Name | AMY LORRAINE STACY MS, RD, CDN
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 156 WEST AVE
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City | BROCKPORT
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State | NY
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Zip | 14420-1229
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Country | US
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Telephone | 585-395-6095
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Fax |
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Provider Business Mailing Address
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Address Line | 7434 MAPLE AVE
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City | BERGEN
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State | NY
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Zip | 14416-9404
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Country | US
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Telephone | 585-494-1505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 000777-1
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License Number State | NY
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