Provider Demographics
NPI:1821982356
Name:ST CLAR, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:ST CLAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7414 HENDRICKS DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1729
Mailing Address - Country:US
Mailing Address - Phone:240-704-4613
Mailing Address - Fax:
Practice Address - Street 1:307 RIGGS RD NE APT 206
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2581
Practice Address - Country:US
Practice Address - Phone:240-704-4613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant