Provider Demographics
NPI:1275429466
Name:HASSELL, STEPHANIE (DTR)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HASSELL
Suffix:
Gender:F
Credentials:DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:224 E HOLDING AVE
Mailing Address - Street 2:PO BOX 94
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2903
Mailing Address - Country:US
Mailing Address - Phone:716-222-0297
Mailing Address - Fax:716-794-9466
Practice Address - Street 1:10175 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2941
Practice Address - Country:US
Practice Address - Phone:716-222-0297
Practice Address - Fax:716-794-9466
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered