Provider Demographics
NPI:1679184717
Name:STEGALL, SACY
Entity type:Individual
Prefix:
First Name:SACY
Middle Name:
Last Name:STEGALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 AMANDA DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-8971
Mailing Address - Country:US
Mailing Address - Phone:405-255-2261
Mailing Address - Fax:
Practice Address - Street 1:2902 AMANDA DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-8971
Practice Address - Country:US
Practice Address - Phone:405-255-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist