Provider Demographics
NPI:1659672822
Name:AUSTIN, STACEY ANN (LAC)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ANN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2658 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108-1033
Mailing Address - Country:US
Mailing Address - Phone:716-778-8627
Mailing Address - Fax:
Practice Address - Street 1:2658 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:NY
Practice Address - Zip Code:14108-1033
Practice Address - Country:US
Practice Address - Phone:716-778-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004417-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist