Provider Demographics
NPI:1861890865
Name:SPELLMAN, STACY (LPN)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SPELLMAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-4206
Mailing Address - Country:US
Mailing Address - Phone:917-674-8004
Mailing Address - Fax:718-602-0604
Practice Address - Street 1:333 BRADFORD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-4206
Practice Address - Country:US
Practice Address - Phone:917-674-8004
Practice Address - Fax:718-602-0604
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160224-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse