Individual provider · Type 1 NPI

Stacey Faith Jackson, DO

Student in an Organized Health Care Education/Training Program · New Hyde Park, NY

NPI number 1205539640 Active

Practice location

26901 76th Ave
New Hyde Park, NY 11040-1433

Call (718) 470-8284 Map

Mailing address

26901 76th Ave Rm C028
New Hyde Park, NY 11040-1433

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1205539640

Stacey Faith Jackson, DO's National Provider Identifier is 1205539640, issued on Mar 24, 2023. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in New Hyde Park, NY. The record was last updated on Mar 24, 2023.