Provider Demographics
NPI:1881037398
Name:ELLIOTT, STACEY PATRICIA (DO)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:PATRICIA
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:107 FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-1801
Mailing Address - Country:US
Mailing Address - Phone:315-918-7361
Mailing Address - Fax:315-226-4203
Practice Address - Street 1:107 FAYETTE ST
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-1801
Practice Address - Country:US
Practice Address - Phone:315-918-7361
Practice Address - Fax:315-226-4203
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2887202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry