Provider Demographics
NPI:1285778944
Name:LAURO, STACIE (MD)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:LAURO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:
Other - Last Name:LAURO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3923 W LEONA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7825
Mailing Address - Country:US
Mailing Address - Phone:813-944-8226
Mailing Address - Fax:
Practice Address - Street 1:3923 W LEONA ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7825
Practice Address - Country:US
Practice Address - Phone:813-944-8226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2135922084P0800X
FLME1083882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
P010213592OtherEXCELLUS
NY02409429Medicaid
117788EUOtherPREFERRED CARE
FL003358900Medicaid
DD5819Medicare ID - Type Unspecified