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General NPI Number Information
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NPI Number | 1336978576
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Entity Type | Individual
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Provider Name | STEPHANIE FRY RN, RD, LDN, CDCES
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Gender | Female
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Dates
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Enumeration Date | 07/27/2024
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 632 DEL PRADO BLVD N
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City | CAPE CORAL
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State | FL
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Zip | 33909-2278
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Country | US
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Telephone | 239-343-9646
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Fax | 239-343-9681
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-343-9646
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Fax | 239-343-9681
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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 | 86343660
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 9563454
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | ND12759
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License Number State | FL
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