Provider Demographics
NPI:1619909009
Name:SMALLEY, STACY M (CNM MSN)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:M
Last Name:SMALLEY
Suffix:
Gender:F
Credentials:CNM MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2407
Mailing Address - Country:US
Mailing Address - Phone:845-353-1441
Mailing Address - Fax:845-353-1987
Practice Address - Street 1:258 HIGH AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2407
Practice Address - Country:US
Practice Address - Phone:845-353-1441
Practice Address - Fax:845-353-1987
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001316-1176B00000X
CTLNM000261367A00000X
ARM002126176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
26100OtherCONNECTICARE
40LNM0261CT05OtherANTHEM BLUE CROSS
P3644739OtherTAX ID
060967790OtherOXFORD HEALTHPLAN UNITED
26100OtherCONNECTICARE