Provider Demographics
NPI:1144277617
Name:SHAUP, STACY SANDERS (PHD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:SANDERS
Last Name:SHAUP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 W SAMPLE RD
Mailing Address - Street 2:SUITE 331
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3973
Mailing Address - Country:US
Mailing Address - Phone:954-752-9353
Mailing Address - Fax:954-752-9353
Practice Address - Street 1:10100 W SAMPLE RD
Practice Address - Street 2:SUITE 331
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3973
Practice Address - Country:US
Practice Address - Phone:954-752-9353
Practice Address - Fax:954-752-9353
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7280103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist