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General NPI Number Information
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NPI Number | 1386211415
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Entity Type | Individual
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Provider Name | STACEY CHALYN REGIS M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 4500 SAN PABLO RD S
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City | JACKSONVILLE
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State | FL
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Zip | 32224-1865
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Country | US
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Telephone | 904-953-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 1611 NW 12 AVENUE
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City | MIAMI
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State | FL
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Zip | 33136
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Country | US
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Telephone | 305-585-5215
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Fax | 305-585-8137
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME166909
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License Number State | FL
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