Individual
STACEY CHERYL EDENBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS.,RD
Contact information
Practice address
86 FARM LAKE CRESCENT RD, CHAPPAQUA, NY 10514-3718
(512) 693-7045
Mailing address
86 FARM LAKE CRESCENT RD, CHAPPAQUA, NY 10514-3718
(512) 693-7045
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
814573
NY
Other
Enumeration date
04/21/2026
Last updated
04/21/2026
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