Provider Demographics
NPI:1376969576
Name:DEBARROS, STACY ALLISON (PAC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ALLISON
Last Name:DEBARROS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7125 ORCHARD LAKE RD
Mailing Address - Street 2:STE 316
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3629
Mailing Address - Country:US
Mailing Address - Phone:866-607-2308
Mailing Address - Fax:248-855-5455
Practice Address - Street 1:4010 FORLEY ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1427
Practice Address - Country:US
Practice Address - Phone:718-565-6565
Practice Address - Fax:718-565-6999
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY017427363AM0700X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical