Individual
DR. STACY L. STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1250 E MARSHALL ST, RICHMOND, VA 23298-5051
(601) 426-4739
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
(855) 689-5105
(888) 507-9833
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101267297
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00186342
—
MS
Enumeration date
07/09/2006
Last updated
09/09/2021
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