Provider Demographics
NPI:1982100616
Name:LAM, STACIA SHARONA (MD)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:SHARONA
Last Name:LAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACIA
Other - Middle Name:SHARONA
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON
Mailing Address - Street 2:6431 FANNIN STREET,MSB 7.119
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:713-500-0638
Practice Address - Street 1:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON
Practice Address - Street 2:6431 FANNIN STREET,MSB 7.119
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:971-263-5755
Practice Address - Fax:713-500-0638
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPG2071022084N0400X
OR390200000X
390200000X
TXT91602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program