Provider Demographics
NPI:1831212257
Name:DUNN, STACEY TANTLEFF (PHD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:TANTLEFF
Last Name:DUNN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 S LAKE CLAIRE CIR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7965
Mailing Address - Country:US
Mailing Address - Phone:407-399-7930
Mailing Address - Fax:
Practice Address - Street 1:1345 CLAY ST
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5404
Practice Address - Country:US
Practice Address - Phone:407-399-7930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 5486103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical