Provider Demographics
NPI:1356176283
Name:WINTON, STACY (RD, LD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:WINTON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 N NEW RIVER DR E APT 1810
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3162
Mailing Address - Country:US
Mailing Address - Phone:305-785-3711
Mailing Address - Fax:
Practice Address - Street 1:347 N NEW RIVER DR E APT 1810
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3162
Practice Address - Country:US
Practice Address - Phone:305-785-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6850133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered