Healthcare Provider Details

I. General information

NPI: 1881040103
Provider Name (Legal Business Name): STACEY RENEE SALYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 WYNDHAM RD
AKRON OH
44313-5369
US

IV. Provider business mailing address

3726 LONGLEAF FOREST LN
JACKSONVILLE FL
32210-6896
US

V. Phone/Fax

Practice location:
  • Phone: 904-349-8827
  • Fax:
Mailing address:
  • Phone: 904-900-9689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL315796906690
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: