Provider Demographics
NPI:1275862690
Name:SLAVEN, STACY MARIE (MD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MARIE
Last Name:SLAVEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26112 E WILLISTON AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1145
Mailing Address - Country:US
Mailing Address - Phone:718-347-8888
Mailing Address - Fax:718-347-8889
Practice Address - Street 1:26112 E WILLISTON AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-1145
Practice Address - Country:US
Practice Address - Phone:718-347-8888
Practice Address - Fax:718-347-8889
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249321207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine