Staci H Walden, MSCN, RD/LDN,

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DX3200 Issued in MD

Practice address

417 Academy St
Cambridge, MD 21613-1958

Phone

(410) 228-2474

NPI assigned

Sep 15, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fair Winds Wellness LLC

  • Health Service Clinic/Center
  • Cambridge, MD
  • NPI 1669023974
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570406400000",
    "number": "1285916262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 ACADEMY ST",
            "city": "CAMBRIDGE",
            "state": "MD",
            "postal_code": "216131958",
            "telephone_number": "410-228-2474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 ACADEMY ST",
            "city": "CAMBRIDGE",
            "state": "MD",
            "postal_code": "216131958",
            "telephone_number": "410-228-2474"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "219 S Washington St",
            "address_purpose": "LOCATION",
            "city": "Easton",
            "state": "MD",
            "postal_code": "216012913",
            "country_code": "US",
            "telephone_number": "410-822-1000 x5351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALDEN",
        "first_name": "STACI",
        "middle_name": "H",
        "credential": "MSCN, RD/LDN,",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-15",
        "last_updated": "2019-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MD",
            "license": "DX3200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Salvatore Verteramo, MD
• Cristian P Vilcu, M.D.
• Visions America Community Development Corp.
• Wal-Mart Stores East LP
• Wal-Mart Stores East LP
• Walgreen Co
• Walgreen Co.
• Michael James Ward, DO
• Christopher Michael Warfield, PHARM.D.
• Kawana Laya Webb, LCSW-C

• Registered Dietitian in Cambridge, MD
• Providers in Cambridge, MD by specialty
• Registered Dietitian in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.