Provider Demographics
NPI:1154735868
Name:DURFEE, STACY
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:DURFEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8786
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23450-8786
Mailing Address - Country:US
Mailing Address - Phone:757-422-0409
Mailing Address - Fax:757-422-2124
Practice Address - Street 1:117 S FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4656
Practice Address - Country:US
Practice Address - Phone:757-422-0409
Practice Address - Fax:757-422-2124
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA465276261OtherFEIN