Provider Demographics
NPI:1750841995
Name:SOUCIER, DEVON
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:SOUCIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HIGHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK MEDICINE DEPARTMENT OF OB/GYN, HSC, T9
Practice Address - Street 2:101 NICOLLS ROAD
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8091
Practice Address - Country:US
Practice Address - Phone:631-444-4686
Practice Address - Fax:631-444-4622
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program