Provider Demographics
NPI:1013173806
Name:COX, STACY LYNN
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:COX
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 1:5841 SHAMROCK CT
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4075
Mailing Address - Country:US
Mailing Address - Phone:716-648-0486
Mailing Address - Fax:
Practice Address - Street 1:170 FRANKLIN ST
Practice Address - Street 2:CROSBY BUILDING,SUITE 400
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-2414
Practice Address - Country:US
Practice Address - Phone:716-856-2702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200389-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse