Provider Demographics
NPI:1154614451
Name:STADNICK, TIFFANY ANNE (MD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANNE
Last Name:STADNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9745 N 90TH PLACE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258
Mailing Address - Country:US
Mailing Address - Phone:480-661-1485
Mailing Address - Fax:480-661-1495
Practice Address - Street 1:9745 N 90TH PLACE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-661-1485
Practice Address - Fax:480-661-1495
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49502207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z175852Medicare PIN