Stacey Patricia Elliott, D.O.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

288720 Issued in NY

Practice address

107 Fayette St
Manlius, NY 13104-1801

Phone

(315) 918-7361

Fax

(315) 226-4203

NPI assigned

Apr 15, 2013

Last updated

Jul 15, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1881037398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 FAYETTE ST",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131041801",
            "telephone_number": "315-918-7361",
            "fax_number": "315-226-4203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 FAYETTE ST",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131041801",
            "telephone_number": "315-918-7361",
            "fax_number": "315-226-4203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "STACEY",
        "middle_name": "PATRICIA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-15",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "288720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Bradford Dragon, DMD, MSD
• Darcey A Dwelly, LPN
• Henry M. Eisenberg, M.D.
• Khadija Elharti
• Edious K. Elliot, DMD
• Andrea P Ellis, RN
• Peter H Emery Jr., RPH
• Patricia D Endy, RD
• Charlotte Giovanna Ennis, DPT
• Mark Steven Erlebacher, M.D.

• Psychiatry Physician in Manlius, NY
• Providers in Manlius, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.