Provider Demographics
NPI:1003546037
Name:BAILEY, STASHAUN (CPT, CCMA)
Entity type:Individual
Prefix:
First Name:STASHAUN
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CPT, CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 JEFFERSON STREET NE
Mailing Address - Street 2:STE 150 PMB 3786
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4390
Mailing Address - Country:US
Mailing Address - Phone:202-455-0323
Mailing Address - Fax:
Practice Address - Street 1:2322 SAINT CLAIR DR
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-6845
Practice Address - Country:US
Practice Address - Phone:202-455-0323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MDL2T6A4Z2246ZC0007X
MDF9C8J3D9246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant