Provider Demographics
NPI:1477898724
Name:STASHKO, JAMIE LEE (PSYD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:STASHKO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S SALEM ST
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-1824
Mailing Address - Country:US
Mailing Address - Phone:919-303-0377
Mailing Address - Fax:919-267-6173
Practice Address - Street 1:201 S SALEM ST
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1824
Practice Address - Country:US
Practice Address - Phone:919-303-0377
Practice Address - Fax:919-267-6173
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NC5063103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist