Provider Demographics
NPI:1972968741
Name:DAY, STACY MONDRA
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:MONDRA
Last Name:DAY
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 1:11957 BOB WHITE DR APT 863
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-3949
Mailing Address - Country:US
Mailing Address - Phone:281-642-8018
Mailing Address - Fax:281-642-3386
Practice Address - Street 1:11957 BOB WHITE DR APT 863
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-3949
Practice Address - Country:US
Practice Address - Phone:281-642-8018
Practice Address - Fax:281-642-3386
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator