Provider Demographics
NPI:1376119487
Name:STUCKEY, MICHAELA CONSTANCE DEVINE
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:CONSTANCE DEVINE
Last Name:STUCKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 EAGLEVIEW DR APT 6
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6700
Mailing Address - Country:US
Mailing Address - Phone:513-212-7587
Mailing Address - Fax:
Practice Address - Street 1:8075 READING RD STE 201
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-1415
Practice Address - Country:US
Practice Address - Phone:513-978-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-29
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator