Female

Michelle E. Stack PH.D.

Full Name

Michelle Elena Stack PH.D.

NPI Number

1952671950

NPI Type

Individual Provider

Gender

Female

Enumeration Date

01/06/2012

Specialties

(Taxonomies)

Code

103G00000X
103TC0700X
103TB0200X
103TH0004X
103T00000X

Primary Taxonomy

No
No
No
No
No

Licenses

State

Connecticut
New Mexico

License Number

3230
1195

Contact
Information

Purpose

Mailing
Location

Address

1090 S TAMIAMI TRL
1090 S TAMIAMI TRL

City

Sarasota
Sarasota

State

FL
FL

Postal Code

34236-9116
34236-9116

Country

US
US

Telephone Number

N/A
(941) 363-0878

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 09/19/2022

Provider Address