Healthcare Provider Details

I. General information

NPI: 1487624607
Provider Name (Legal Business Name): STACY ANN NICHOLS-BYLL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY ANN NICHOLS M.D.

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6322 ARBOR DR
SHREWSBURY MA
01545-6017
US

IV. Provider business mailing address

6322 ARBOR DR
SHREWSBURY MA
01545-6017
US

V. Phone/Fax

Practice location:
  • Phone: 830-399-5455
  • Fax:
Mailing address:
  • Phone: 830-399-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-34598
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18698
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME111597
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-41725
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2426
License Number StateVI
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21188
License Number StateNE
# 7
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01049920A
License Number StateIN
# 8
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1020891
License Number StateMA
# 9
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101245035
License Number StateVA
# 10
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2024-0675
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: