Healthcare Provider Details

I. General information

NPI: 1548878887
Provider Name (Legal Business Name): LAMEI STUCKEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 DUKE ST
ALEXANDRIA VA
22314-5219
US

IV. Provider business mailing address

1219 SKYLARK DR
WESTON FL
33327-2380
US

V. Phone/Fax

Practice location:
  • Phone: 703-870-3880
  • Fax:
Mailing address:
  • Phone: 540-922-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: