Provider Demographics
NPI:1861769531
Name:STEWART, MICHELLE J (MPH, RD, LD, N, CDE)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:J
Last Name:STEWART
Suffix:
Gender:F
Credentials:MPH, RD, LD, N, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 SATINLEAF ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-4815
Mailing Address - Country:US
Mailing Address - Phone:954-927-9062
Mailing Address - Fax:954-927-9048
Practice Address - Street 1:1050 SATINLEAF ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-4815
Practice Address - Country:US
Practice Address - Phone:954-927-9062
Practice Address - Fax:877-647-0535
Is Sole Proprietor?:No
Enumeration Date:2011-11-24
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 4295133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist