Healthcare Provider Details

I. General information

NPI: 1851614705
Provider Name (Legal Business Name): STACEY STELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2010
Last Update Date: 03/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 GRAND AVE
ENGLEWOOD NJ
07631-4356
US

IV. Provider business mailing address

392 E 10TH ST APT 5W
NEW YORK NY
10009-9201
US

V. Phone/Fax

Practice location:
  • Phone: 201-568-0900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTL-1795
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: