Provider Demographics
NPI:1619153392
Name:ROBINSON, STACY ALEX (PA-C)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:ALEX
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-0149
Mailing Address - Country:US
Mailing Address - Phone:203-927-8392
Mailing Address - Fax:
Practice Address - Street 1:98 HIGH MEADOW RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2010
Practice Address - Country:US
Practice Address - Phone:203-927-8392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-13
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000986363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant