Provider Demographics
NPI:1538029863
Name:BAHADUR, STACY ANN
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:ANN
Last Name:BAHADUR
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 1:5890 S PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5937
Mailing Address - Country:US
Mailing Address - Phone:954-800-5433
Mailing Address - Fax:
Practice Address - Street 1:7871 NW 15TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-5169
Practice Address - Country:US
Practice Address - Phone:954-800-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-18
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9416865163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty