Provider Demographics
NPI:1952561839
Name:LINDO-UKATA, STACEY MARIE (MD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:MARIE
Last Name:LINDO-UKATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:MARIE
Other - Last Name:LINDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11001 DURANT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8390
Mailing Address - Country:US
Mailing Address - Phone:919-781-2500
Mailing Address - Fax:910-781-9247
Practice Address - Street 1:11001 DURANT RD STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8390
Practice Address - Country:US
Practice Address - Phone:919-781-2500
Practice Address - Fax:910-781-9247
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01592207V00000X
GA67500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003125861AMedicaid
GA67500OtherGA LIC NUMBER
NC2014-01592OtherNC LICENSE