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TRACEY MARIE SOUTHARD
NPI 1215298260
Specialist in Medford, NY

Active since June 06, 2012
1 SCOUTING BLVD, MEDFORD, NY 11763(631) 745-0317 Get Directions Write a Review

NPPES record last updated: June 6, 2012. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Tracey Marie Southard NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TRACEY MARIE SOUTHARD (NPI 1215298260) is an individual specialist in Medford, New York, licensed in New York (764610) and active in the NPI registry since June 2012.

NPPES Registry Identity

NPI1215298260
Entity TypeIndividualFemale
Primary Taxonomy174400000X
Provider Legal NameTRACEY MARIE SOUTHARD
Location Address1 SCOUTING BLVDMedford, NY 11763-2220
Mailing Address132 La Bonne Vie Dr W Apt JEast Patchogue, NY 11772-4560 · (631) 745-0317
Phone(631) 745-0317
Sole ProprietorYes
Enumeration DateJune 6, 2012
✔ NPI 1215298260 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in NY · 764610
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
1 SCOUTING BLVD, Medford, NY 11763
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LORI MERCK
Behavior Analyst
1 SCOUTING BLVD
MEDFORD, NY 11763
Suffolk County (631) 297-3202
KASEY ANN VITALE
Specialist
1 SCOUTING BLVD
MEDFORD, NY 11763
Suffolk County (631) 297-3202
ALLISON TYSKA-PETTERSEN
Specialist
1 SCOUTING BLVD
MEDFORD, NY 11763
Suffolk County (631) 297-3200
BEVIN ANN FLEMMING
Specialist
1 SCOUTING BLVD
MEDFORD, NY 11763
Suffolk County (631) 297-3202
EILEEN LEARY ROGGEMANN
Specialist/Technologist, Other
1 SCOUTING BLVD
MEDFORD, NY 11763
Suffolk County (631) 297-3202
NICOLE RYANN MIHALIK MA
Early Intervention Provider Agency
1 SCOUTING BLVD
MEDFORD, NY 11763
Suffolk County (631) 297-3201
OLIVIA ANN FERTMANN
Specialist
1 SCOUTING BLVD
MEDFORD, NY 11763
Suffolk County (631) 297-3202
ANDREA VERIOS
Early Intervention Provider Agency
1 SCOUTING BLVD
MEDFORD, NY 11763
Suffolk County (631) 297-3202

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tracey Southard's NPI number?

The NPI number for Tracey Southard is 1215298260. It was assigned to this individual provider in the NPPES registry on June 6, 2012.

Where is Tracey Southard located?

Tracey Southard practices at 1 Scouting Blvd, Medford, NY 11763. The listed phone number is (631) 745-0317.

What is Tracey Southard's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Tracey Southard was last updated on June 6, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.