Provider Demographics
NPI:1356648513
Name:NEWMAN, STACY JEANNE (MS)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:JEANNE
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 COUNTRY CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-6002
Mailing Address - Country:US
Mailing Address - Phone:540-539-5475
Mailing Address - Fax:
Practice Address - Street 1:124 COUNTRY CLUB CIR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-6002
Practice Address - Country:US
Practice Address - Phone:540-539-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPGP-565821171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor