Provider Demographics
NPI:1710442694
Name:CICERO, STACI RUTH (RN)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:RUTH
Last Name:CICERO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CRIMMINS RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5327
Mailing Address - Country:US
Mailing Address - Phone:203-655-3036
Mailing Address - Fax:
Practice Address - Street 1:11 CRIMMINS RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-5327
Practice Address - Country:US
Practice Address - Phone:203-655-3036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE53362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics