Healthcare Provider Details

I. General information

NPI: 1902236680
Provider Name (Legal Business Name): DAVID STUCKEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 MASONIC ST STE A
NORTHAMPTON MA
01060-3038
US

IV. Provider business mailing address

7031 SW 62ND AVE
SOUTH MIAMI FL
33143-4701
US

V. Phone/Fax

Practice location:
  • Phone: 413-320-4191
  • Fax: 413-341-1528
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberUO3819
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberUO3819
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: