MEDICARE: STACEY L SENSOR DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	OS13177	FL
2	207V00000X	Obstetrics & Gynecology Physician	5101012638	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588658579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY L SENSOR DO

Provider Business Mailing Address
First Line	:	6376 PINE RIDGE RD STE 300
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-3908
Country	:	US
Telephone Number	:	239-348-4399
Fax Number	:	407-333-1617

Provider Business Practice Location Address
First Line	:	6376 PINE RIDGE RD STE 300
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-3908
Country	:	US
Telephone Number	:	239-348-4399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	08/29/2025

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