Active NPI
Stacey Michelle Nedrud, MD, DMD
- Oral & Maxillofacial Surgery (D.M.D.)
- Jacksonville, FL
National Provider Identifier
1891113205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral & Maxillofacial Surgery (D.M.D.)
- License
- ME149400
- Practice address
- 7711 Baymeadows Rd E Ste 7
Jacksonville, FL 32256-9110 - Phone
- (321) 591-1840
- NPI assigned
- Apr 2, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | ME149400 | FL | Primary |
Addresses
Primary practice location
7711 Baymeadows Rd E Ste 7
Jacksonville, FL 32256-9110
Mailing address
7711 Baymeadows Rd E Ste 7
Jacksonville, FL 32256-9110
Phone (321) 591-1840
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2024 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME149400 | FL | MD | Oral & Maxillofacial Surgery (D.M.D.) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1396396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722211200000",
"number": "1891113205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7711 BAYMEADOWS RD E STE 7",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322569110",
"telephone_number": "321-591-1840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7711 BAYMEADOWS RD E STE 7",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322569110",
"telephone_number": "321-591-1840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEDRUD",
"first_name": "STACEY",
"middle_name": "MICHELLE",
"credential": "MD, DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-02",
"last_updated": "2024-07-29",
"certification_date": "2024-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "204E00000X",
"taxonomy_group": "",
"desc": "Oral & Maxillofacial Surgery",
"state": "FL",
"license": "ME149400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.