Provider Demographics
NPI:1215500111
Name:RODRIGUEZ, STIVALY (MD)
Entity type:Individual
Prefix:
First Name:STIVALY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STIVALY
Other - Middle Name:
Other - Last Name:QUEZADA RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:380R MERRIMACK ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5884
Mailing Address - Country:US
Mailing Address - Phone:978-687-6355
Mailing Address - Fax:
Practice Address - Street 1:380R MERRIMACK ST STE 3B
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5884
Practice Address - Country:US
Practice Address - Phone:978-687-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR35284R208000000X
MA1014721208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics