Provider Demographics
NPI:1730583360
Name:O'BRIEN, STACY A (AUD)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:A
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 DUNLAWTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-2905
Mailing Address - Country:US
Mailing Address - Phone:386-756-8225
Mailing Address - Fax:386-767-0742
Practice Address - Street 1:1185 DUNLAWTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-2905
Practice Address - Country:US
Practice Address - Phone:386-756-8225
Practice Address - Fax:386-767-0742
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1882231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist