Provider Demographics
NPI:1649674805
Name:STACY SANDERS SHAUP, PHD, PLLC
Entity type:Organization
Organization Name:STACY SANDERS SHAUP, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAUP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-752-9353
Mailing Address - Street 1:10100 W SAMPLE RD
Mailing Address - Street 2:SUITE 331
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3973
Mailing Address - Country:US
Mailing Address - Phone:954-752-9353
Mailing Address - Fax:954-752-9353
Practice Address - Street 1:10100 W SAMPLE RD
Practice Address - Street 2:SUITE 331
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3973
Practice Address - Country:US
Practice Address - Phone:954-752-9353
Practice Address - Fax:954-752-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7280103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty