Basic Information
| Provider Information | |||||||||
| NPI: | 1518229343 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEYERS | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.S. SPEC. ED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3894 WILLOWVALE RD | ||||||||
| Address2: | |||||||||
| City: | MORRISVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134081704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158821111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1045 JAMES ST | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132032730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154251004 | ||||||||
| FaxNumber: | 3154224855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |
No ID Information.