Provider Demographics
NPI:1588658579
Name:SENSOR, STACEY L (DO)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:SENSOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:829 N CENTER AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1598
Mailing Address - Country:US
Mailing Address - Phone:407-333-1616
Mailing Address - Fax:407-333-1617
Practice Address - Street 1:1071 S SUN DR STE 1043
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2573
Practice Address - Country:US
Practice Address - Phone:407-333-1616
Practice Address - Fax:407-333-1617
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI41075207V00000X
MI5101012638207V00000X
FLOS13177207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015507400Medicaid
FLIG043ZMedicare PIN
FL015507400Medicaid