Provider Demographics
NPI:1386211415
Name:REGIS, STACEY CHALYN DANELLA NADIA (MD)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:CHALYN DANELLA NADIA
Last Name:REGIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 NW 12 AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:305-585-5215
Mailing Address - Fax:305-585-8137
Practice Address - Street 1:1611 NW 12 AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-585-5215
Practice Address - Fax:305-585-8137
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2023-03-21
Deactivation Date:2023-03-16
Deactivation Code:
Reactivation Date:2023-03-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program