Individual
AMY LORRAINE STACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, CDN
Contact information
Practice address
156 WEST AVE, BROCKPORT, NY 14420-1229
(585) 395-6095
Mailing address
7434 MAPLE AVE, BERGEN, NY 14416-9404
(585) 494-1505
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
000777-1
NY
Other
Enumeration date
04/23/2007
Last updated
07/08/2007
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