Provider Demographics
NPI:1922289776
Name:MCCLAY, STACYE LYNN
Entity Type:Individual
Prefix:MRS
First Name:STACYE
Middle Name:LYNN
Last Name:MCCLAY
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 1:3027 ROUTE 50
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2926
Mailing Address - Country:US
Mailing Address - Phone:518-587-2202
Mailing Address - Fax:518-587-4920
Practice Address - Street 1:3027 ROUTE 50
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2926
Practice Address - Country:US
Practice Address - Phone:518-587-2202
Practice Address - Fax:518-587-4920
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00361317Medicaid