Healthcare Provider Details

I. General information

NPI: 1518700400
Provider Name (Legal Business Name): STEFANAE SHAELYN LOY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 N DIXIE HWY STE 4
ELIZABETHTOWN KY
42701-4650
US

IV. Provider business mailing address

326 MADISON DR
ELIZABETHTOWN KY
42701-2165
US

V. Phone/Fax

Practice location:
  • Phone: 270-982-1555
  • Fax:
Mailing address:
  • Phone: 559-307-7297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number303461
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: