Provider Demographics
NPI:1568609121
Name:JUNE, STACEY LAUREN (DO)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LAUREN
Last Name:JUNE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:107 NEWTOWN ROAD SUITE 2C
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4146
Mailing Address - Country:US
Mailing Address - Phone:203-791-9661
Mailing Address - Fax:203-730-4162
Practice Address - Street 1:107 NEWTOWN ROAD SUITE 2C
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-791-9661
Practice Address - Fax:203-730-4162
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0151942086S0122X
CT640262086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA239852LEBMedicare PIN