1144277617 NPI number — STACY SANDERS SHAUP PH.D.

Table of content: STACY SANDERS SHAUP PH.D. (NPI 1144277617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144277617 NPI number — STACY SANDERS SHAUP PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAUP
Provider First Name:
STACY
Provider Middle Name:
SANDERS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144277617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10100 W SAMPLE RD
Provider Second Line Business Mailing Address:
SUITE 331
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33065-3973
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-752-9353
Provider Business Mailing Address Fax Number:
954-752-9353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10100 W SAMPLE RD
Provider Second Line Business Practice Location Address:
SUITE 331
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33065-3973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-752-9353
Provider Business Practice Location Address Fax Number:
954-752-9353
Provider Enumeration Date:
05/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PY 7280 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)