Healthcare Provider Details

I. General information

NPI: 1346297744
Provider Name (Legal Business Name): ROBYN M STAUBACH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5352 W CORRAL PL
BEVERLY HILLS FL
34465-2772
US

IV. Provider business mailing address

81 DARTMOUTH ST APT 304
PITTSFIELD MA
01201-3531
US

V. Phone/Fax

Practice location:
  • Phone: 413-281-5061
  • Fax:
Mailing address:
  • Phone: 413-281-6051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number204885
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: