Provider Demographics
NPI:1114805405
Name:STEFANIDES, ALLYSON L
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:L
Last Name:STEFANIDES
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:L
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19227 FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4166
Mailing Address - Country:US
Mailing Address - Phone:586-345-7196
Mailing Address - Fax:
Practice Address - Street 1:38800 GARFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6619
Practice Address - Country:US
Practice Address - Phone:586-231-0306
Practice Address - Fax:586-231-0307
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program