Healthcare Provider Details

I. General information

NPI: 1649541129
Provider Name (Legal Business Name): STACY DAVIS PSY.D, M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2012
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 NW 82ND AVE STE 400-3
DORAL FL
33166-6652
US

IV. Provider business mailing address

3625 NW 82ND AVE STE 400-3
DORAL FL
33166-6652
US

V. Phone/Fax

Practice location:
  • Phone: 786-505-5037
  • Fax:
Mailing address:
  • Phone: 786-505-5037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: