Organization
STEPHEN LACKY CHASTAIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REGINA MARSHALL (BILLING MANAGER)
(772) 581-3991
Entity
Organization
Contact information
Practice address
5850 SE COMMUNITY DR, STUART, FL 34997-6420
(772) 324-3901
(772) 324-3019
Mailing address
9611 N US HIGHWAY 1, #166, SEBASTIAN, FL 32958-6363
(772) 581-3990
(772) 581-3991
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME114042
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009031100
—
FL
01
—
61656
BCBS
FL
01
—
ME114042
LICENSE
FL
Enumeration date
11/19/2015
Last updated
11/19/2015
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