Healthcare Provider Details

I. General information

NPI: 1306756515
Provider Name (Legal Business Name): MASEY J STAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 23RD ST
COLUMBUS NE
68601-3427
US

IV. Provider business mailing address

2021 23RD ST
COLUMBUS NE
68601-3427
US

V. Phone/Fax

Practice location:
  • Phone: 443-656-9050
  • Fax: 402-564-2026
Mailing address:
  • Phone: 443-656-9050
  • Fax: 402-564-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1522762
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: