Provider Demographics
NPI:1033441837
Name:MAHAFFEY, STACY RAE (CST)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:RAE
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 BLAKE AVENUE
Mailing Address - Street 2:SUITE 207 ROCKY MOUNTAIN PLASTIC SURGERY
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601
Mailing Address - Country:US
Mailing Address - Phone:970-945-1144
Mailing Address - Fax:970-945-9138
Practice Address - Street 1:1830 BLAKE AVENUE
Practice Address - Street 2:SUITE 207
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601
Practice Address - Country:US
Practice Address - Phone:970-945-1144
Practice Address - Fax:970-945-9138
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other