Provider Demographics
NPI:1447406905
Name:WARNOCK, STACY DEIDRE (AU)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:DEIDRE
Last Name:WARNOCK
Suffix:
Gender:F
Credentials:AU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8181 NW 154TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5861
Mailing Address - Country:US
Mailing Address - Phone:055-583-7243
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:5830 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-4311
Practice Address - Country:US
Practice Address - Phone:407-658-0228
Practice Address - Fax:407-282-5483
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 1422231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist