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General NPI Number Information
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NPI Number | 1679152862
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Entity Type | Individual
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Provider Name | STEPHANIE NELSON PETROSKY RDN
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Gender | Female
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 3200 S UNIVERSITY DR
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City | DAVIE
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State | FL
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Zip | 33328-2018
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Country | US
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Telephone | 954-262-1597
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Fax |
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Provider Business Mailing Address
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Address Line | 7600 SW 36TH ST DEPARTMENT OF NUTRITION
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City | DAVIE
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State | FL
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Zip | 33328-1902
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Country | US
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Telephone | 954-262-1597
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | ND000373
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number | ND000373
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | ND000373
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License Number State | FL
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