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General NPI Number Information
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NPI Number | 1962159384
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Entity Type | Organization
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Legal Business Name | STACEY SIMON NUTRITION LLC
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Dates
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Enumeration Date | 03/05/2022
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 480 BEDFORD RD STE 3201
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City | CHAPPAQUA
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State | NY
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Zip | 10514-1726
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Country | US
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Telephone | 603-264-7382
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Fax |
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Provider Business Mailing Address
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Address Line | 98 DEERFIELD LN N
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City | PLEASANTVILLE
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State | NY
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Zip | 10570-1406
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Country | US
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Telephone | 603-264-7382
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STACEY ELIZABETH SIMON
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Credential |
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Telephone | 603-264-7382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1101X
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Taxonomy Name | Gerontological Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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