Stacey Ann Vanderwel, RD, CSP, LDN

Primary specialty

Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X

License

L002810 Issued in NC

Practice address

505 East Blvd
Suite 200
Charlotte, NC 28203-5105

Phone

(704) 542-2512

NPI assigned

Jul 9, 2008

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

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

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215561600000",
    "number": "1629231683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7225 DELOACH CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282709514",
            "telephone_number": "704-340-1604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 EAST BLVD",
            "address_2": "SUITE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035105",
            "telephone_number": "704-542-2512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERWEL",
        "first_name": "STACEY",
        "middle_name": "ANN",
        "credential": "RD, CSP, LDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-09",
        "last_updated": "2008-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "NC",
            "license": "L002810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren May Vanderlip, CRNA
• Margarette Megan Vanderploeg, PA
• Craig Andrew Vanderveer, MD
• Yenny Astrid-Angel Vanderwaerden, MD
• Mark Roger Vanderwel, MD
• Thomas Jackson Vandiver, MD
• Lesley Vandyck, MS CCC-SLP
• Roy Neil Vandyke, D.C.
• Ashley M Vanexel
• Kong Vang, DMD

• Pediatric Nutrition Registered Dietitian in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Pediatric Nutrition Registered Dietitian in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; 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.