Organization
STACEY SIMON NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY ELIZABETH SIMON (OWNER)
(603) 264-7382
Entity
Organization
Contact information
Practice address
480 BEDFORD RD STE 3201, CHAPPAQUA, NY 10514-1726
(603) 264-7382
Mailing address
98 DEERFIELD LN N, PLEASANTVILLE, NY 10570-1406
(603) 264-7382
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
133VN1101X
Gerontological Nutrition Registered Dietitian
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6303777
CIGNA
NY
Enumeration date
03/05/2022
Last updated
03/25/2026
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