Provider Demographics
NPI:1255867529
Name:OLSEN, STACI (MD)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-815-6760
Mailing Address - Fax:585-344-7370
Practice Address - Street 1:16 BANK ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2250
Practice Address - Country:US
Practice Address - Phone:585-815-6760
Practice Address - Fax:585-344-7370
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY306633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine