Healthcare Provider Details

I. General information

NPI: 1568755163
Provider Name (Legal Business Name): SYLVIE STACY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYLVIE BOITEAU

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 20TH ST N STE 1220
BIRMINGHAM AL
35203-4606
US

IV. Provider business mailing address

11209 DEAD RIVER RD
TAVARES FL
32778-4800
US

V. Phone/Fax

Practice location:
  • Phone: 508-648-2546
  • Fax: 888-383-6721
Mailing address:
  • Phone: 508-648-2546
  • Fax: 888-383-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number451223
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number261783
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number42121
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101257328
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number123644
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number33410
License Number StateAL
# 7
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD219042
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: