Healthcare Provider Details

I. General information

NPI: 1265687198
Provider Name (Legal Business Name): STACEY MARIE KUHFAHL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY MARIE CORYELL

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17021 OLD ORCHARD RD UNIT 4
LEWES DE
19958
US

IV. Provider business mailing address

17021 OLD ORCHARD RD UNIT 4
LEWES DE
19958
US

V. Phone/Fax

Practice location:
  • Phone: 302-329-8712
  • Fax: 302-481-1330
Mailing address:
  • Phone: 302-329-8712
  • Fax: 302-481-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB08910400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC2-0023949
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: