Provider Demographics
NPI:1508254988
Name:GIGLIO, STACY KAY (LPN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:KAY
Last Name:GIGLIO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:KAY
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:333 WILEY BLVD.
Mailing Address - City:CAPE VINCENT
Mailing Address - State:NY
Mailing Address - Zip Code:13618-0631
Mailing Address - Country:US
Mailing Address - Phone:315-777-2121
Mailing Address - Fax:
Practice Address - Street 1:333 WILEY BLVD.
Practice Address - Street 2:
Practice Address - City:CAPE VINCENT
Practice Address - State:NY
Practice Address - Zip Code:13618
Practice Address - Country:US
Practice Address - Phone:315-777-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311825-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse