Individual
STACIE B PEDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3100 SW 62ND AVE, MIAMI, FL 33155-3009
(305) 666-6511
Mailing address
3100 SW 62ND AVE, MIAMI, FL 33155-3009
(305) 666-6511
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD426570
PA
2080P0202X
Pediatric Cardiology Physician
MD426570
PA
2080P0203X
Pediatric Critical Care Medicine Physician
D92544
MD
2080P0203X
Pediatric Critical Care Medicine Physician
MD426570
PA
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
ME167338
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0092967
—
NJ
05
—
101470283
—
PA
01
—
242289EMD
MEDICARE PTAN
PA
05
—
659065900
—
MD
Enumeration date
07/18/2006
Last updated
04/02/2024
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