Provider Demographics
NPI:1295132058
Name:STACIE DEE LLC
Entity type:Organization
Organization Name:STACIE DEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:860-604-8585
Mailing Address - Street 1:525 E 72ND ST
Mailing Address - Street 2:APARTMENT 35B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-9601
Mailing Address - Country:US
Mailing Address - Phone:860-604-8585
Mailing Address - Fax:
Practice Address - Street 1:525 E 72ND ST
Practice Address - Street 2:APARTMENT 35B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-9601
Practice Address - Country:US
Practice Address - Phone:860-604-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401771-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty