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NPI Code Detail

MEDICARE: STACEY ROY

MEDICARE: STACEY ROY
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
1363LF0000XFamily Nurse Practitioner8993CT

General Provider Information

NPI Number : 1508489519
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY ROY
Provider Business Mailing Address
First Line : 525 BUCKLAND RD
Second Line :
City : SOUTH WINDSOR
State : CT
Zip : 06074-3746
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 525 BUCKLAND RD
Second Line :
City : SOUTH WINDSOR
State : CT
Zip : 06074-3746
Country : US
Telephone Number : 860-644-4241
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2020
Last Update Date : 09/30/2020

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Directions to “ STACEY ROY ” Practice Location

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