Provider Demographics
NPI:1013419464
Name:DORADO, STACY MAREE (PA-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MAREE
Last Name:DORADO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 ALTON RD STE 610
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4559
Mailing Address - Country:US
Mailing Address - Phone:305-423-3939
Mailing Address - Fax:305-674-8836
Practice Address - Street 1:4308 ALTON RD STE 610
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4559
Practice Address - Country:US
Practice Address - Phone:305-423-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111072363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical