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:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6376 PINE RIDGE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3908
Mailing Address - Country:US
Mailing Address - Phone:239-348-4399
Mailing Address - Fax:407-333-1617
Practice Address - Street 1:6376 PINE RIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3908
Practice Address - Country:US
Practice Address - Phone:239-348-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13177207V00000X, 207V00000X
MI5101012638207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015507400Medicaid
FLIG043ZMedicare PIN
FL015507400Medicaid