Provider Demographics
NPI:1609195387
Name:ESPAILLAT, STACEY (MD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:ESPAILLAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:HAUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1107 EATON AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1862
Mailing Address - Country:US
Mailing Address - Phone:484-526-2400
Mailing Address - Fax:484-526-3697
Practice Address - Street 1:1107 EATON AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-1862
Practice Address - Country:US
Practice Address - Phone:484-526-2400
Practice Address - Fax:484-526-3697
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1175442084P0800X
PAMD4546652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry