Basic Information
| Provider Information | |||||||||
| NPI: | 1184665606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | JULIET | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4801 SWIFT RD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342315139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419213000 | ||||||||
| FaxNumber: | 9419213066 | ||||||||
| Practice Location | |||||||||
| Address1: | 4801 SWIFT RD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342315139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419213000 | ||||||||
| FaxNumber: | 9419213066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 05/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | PO-3139 | FL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 50392 | 01 | FL | BCBS | OTHER |