Provider Demographics
NPI:1700500865
Name:STIFF, DONALD RAY (CRPS-V,A,F)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RAY
Last Name:STIFF
Suffix:
Gender:M
Credentials:CRPS-V,A,F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-4498
Mailing Address - Country:US
Mailing Address - Phone:386-310-9474
Mailing Address - Fax:
Practice Address - Street 1:306 5TH AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-4498
Practice Address - Country:US
Practice Address - Phone:386-310-9474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRPS.397405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty