# STACY GREETER, MD, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700311818
- **Authorized official:** DR. STACY LYNN GREETER MD (PHYSICIAN)
- **Authorized official phone:** (904) 228-0777

## Contact information

- **Practice address:** 9030 58TH DR E, SUITE 101A, ROOM A, BRADENTON, FL 34202-6108
- **Practice address phone:** (941) 413-0834
- **Practice address fax:** (941) 761-5547
- **Mailing address:** 9030 58TH DR E, SUITE 101A, ROOM A, BRADENTON, FL 34202-6108
- **Mailing address phone:** (941) 413-0834
- **Mailing address fax:** (941) 761-5547

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | ME 128423 | FL | Yes |

## Other

- **Enumeration date:** 04/26/2017
- **Last updated:** 04/26/2017