Provider Demographics
NPI:1639370901
Name:NEFF, STACY (DO)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:NEFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PINE HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4783
Mailing Address - Country:US
Mailing Address - Phone:618-334-1836
Mailing Address - Fax:
Practice Address - Street 1:150 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1161
Practice Address - Country:US
Practice Address - Phone:618-664-2922
Practice Address - Fax:618-664-0318
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005020155390200000X
IL1233212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program