Active NPI
Suzanne E Stacey, RD, LD
- Registered Dietitian
- Odessa, FL
National Provider Identifier
1124220108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ND4959
- Practice address
- 2040 Short Ave
Suite 100
Odessa, FL 33556-3445 - Phone
- (727) 372-9922
- Fax
- (727) 372-8477
- NPI assigned
- Jun 3, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | ND4959 | FL | Primary |
Addresses
Primary practice location
2040 Short Ave
Suite 100
Odessa, FL 33556-3445
Mailing address
3629 McCloud St
New Port Richey, FL 34655-2609
Phone (727) 834-8199
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND4959 | FL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272499200000",
"number": "1124220108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3629 MCCLOUD ST",
"city": "NEW PORT RICHEY",
"state": "FL",
"postal_code": "346552609",
"telephone_number": "727-834-8199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2040 SHORT AVE",
"address_2": "SUITE 100",
"city": "ODESSA",
"state": "FL",
"postal_code": "335563445",
"telephone_number": "727-372-9922",
"fax_number": "727-372-8477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACEY",
"first_name": "SUZANNE",
"middle_name": "E",
"credential": "RD, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-03",
"last_updated": "2010-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "ND4959",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Odessa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.