Provider Demographics
NPI:1073504965
Name:SHOUP, STACY LYNN (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:LYNN
Last Name:SHOUP
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 YARDLEY PL
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8917
Mailing Address - Country:US
Mailing Address - Phone:302-235-2472
Mailing Address - Fax:302-733-3074
Practice Address - Street 1:4755 OGLETOWN-STANTON ROAD
Practice Address - Street 2:RM 1988
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-0001
Practice Address - Country:US
Practice Address - Phone:302-733-3072
Practice Address - Fax:302-733-3074
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS