Provider Demographics
NPI:1215131404
Name:AYMOND, STEPHANIE CAMILLE (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CAMILLE
Last Name:AYMOND
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:PO BOX 94522
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6822
Mailing Address - Country:US
Mailing Address - Phone:952-542-8553
Mailing Address - Fax:952-513-6880
Practice Address - Street 1:33801 1ST WAY S STE 101
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6219
Practice Address - Country:US
Practice Address - Phone:253-942-7226
Practice Address - Fax:214-266-3302
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM03462085R0202X
WAMD610298572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology