Provider Demographics
NPI:1871139998
Name:ROY, STACY (MS)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 TARAVAL ST # 255
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2422
Mailing Address - Country:US
Mailing Address - Phone:415-890-6720
Mailing Address - Fax:
Practice Address - Street 1:1930 RAINIER CIR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-8510
Practice Address - Country:US
Practice Address - Phone:707-337-3259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-24
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty