Provider Demographics
NPI:1710972492
Name:MCCONKEY, STACY A (MD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:MCCONKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:A
Other - Last Name:YODER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15502 STONEYBROOK WEST PKWY
Mailing Address - Street 2:SUITE 2-108
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4767
Mailing Address - Country:US
Mailing Address - Phone:407-656-0042
Mailing Address - Fax:407-656-0663
Practice Address - Street 1:15502 STONEYBROOK WEST PKWY
Practice Address - Street 2:SUITE 2-108
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4767
Practice Address - Country:US
Practice Address - Phone:407-656-0042
Practice Address - Fax:407-656-0663
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 113754208000000X
IA32386208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0251819Medicaid
IA43666OtherWELLMARK BCBS
IA43666OtherWELLMARK BCBS
IA370020246Medicare PIN
IA0251819Medicaid