Provider Demographics
NPI:1730698697
Name:STONE, JACQUELINE (MS, RD, CEDRD, LD/N)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:MS, RD, CEDRD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 NE 197TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3116
Mailing Address - Country:US
Mailing Address - Phone:786-797-7255
Mailing Address - Fax:
Practice Address - Street 1:1895 NE 197TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179
Practice Address - Country:US
Practice Address - Phone:786-797-7255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86048647133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered