Provider Demographics
NPI:1548131105
Name:STGELAIS, HAILEY
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:STGELAIS
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 1:2560 JUDGE FRAN JAMIESON WAY UNIT 1305
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6199
Mailing Address - Country:US
Mailing Address - Phone:518-925-6725
Mailing Address - Fax:
Practice Address - Street 1:7975 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8243
Practice Address - Country:US
Practice Address - Phone:321-751-7534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL68789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist