Provider Demographics
NPI:1902909245
Name:ZHANG, STEPHANIE S (RD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:S
Last Name:ZHANG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30170
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-7170
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3506 KENNETT PIKE
Practice Address - Street 2:CCHS PMRI
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807
Practice Address - Country:US
Practice Address - Phone:302-661-3000
Practice Address - Fax:302-661-3470
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2202485133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
2202485OtherCERTIFICATE #
DE020967C49Medicare PIN