Provider Demographics
NPI:1407462534
Name:MASSARI, STACY (RRT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:MASSARI
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 GANDY BLVD N UNIT 1115
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2127
Mailing Address - Country:US
Mailing Address - Phone:732-670-9143
Mailing Address - Fax:
Practice Address - Street 1:6403 JOSEPHINE ARBOR PL
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3155
Practice Address - Country:US
Practice Address - Phone:813-363-2267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14284227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered