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General NPI Number Information
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NPI Number | 1902240864
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Entity Type | Individual
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Provider Name | STACEY DOMINY MA
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Gender | Female
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 3408 S ATLANTIC AVE
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City | DAYTONA BEACH SHORES
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State | FL
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Zip | 32118-6311
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Country | US
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Telephone | 386-767-3752
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Fax | 386-767-4319
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Provider Business Mailing Address
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Address Line | 1901 EDEN DR
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City | DELTONA
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State | FL
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Zip | 32725-3749
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Country | US
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Telephone | 386-295-8485
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-17-26955
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License Number State | FL
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