MEDICARE: DR. STACY MARIE EAGLE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	259629	NY

General Provider Information

NPI Number	:	1376858993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY MARIE EAGLE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1559
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-0989
Country	:	US
Telephone Number	:	631-444-0650
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 NICOLLS ROAD
Second Line	:	DEPARTMENT OF PSYCHIATRY HSC, T-10-020
City	:	STONY BROOK
State	:	NY
Zip	:	11790-0989
Country	:	US
Telephone Number	:	631-444-0650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	11/03/2015

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