Provider Demographics
NPI:1639559107
Name:NASSAU, STACY MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:MARIE
Last Name:NASSAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:MARIE
Other - Last Name:CLEMENTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2699 STIRLING RD STE B100
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6543
Mailing Address - Country:US
Mailing Address - Phone:305-223-8808
Mailing Address - Fax:954-962-9657
Practice Address - Street 1:14411 S DIXIE HWY STE 223
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7900
Practice Address - Country:US
Practice Address - Phone:305-255-4868
Practice Address - Fax:305-255-4922
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-31
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME146805207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty