Provider Demographics
NPI:1013194760
Name:DIORIO, STACEY A (MS, CCC-SP)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:A
Last Name:DIORIO
Suffix:
Gender:F
Credentials:MS, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 LITHIA PINECREST RD STE 135
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6302
Mailing Address - Country:US
Mailing Address - Phone:813-391-8398
Mailing Address - Fax:800-787-5052
Practice Address - Street 1:3433 LITHIA PINECREST RD STE 135
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6302
Practice Address - Country:US
Practice Address - Phone:813-391-8398
Practice Address - Fax:800-787-5052
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3896235Z00000X
FL23137235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA226538OtherMEDICARE A