Provider Demographics
NPI:1407641905
Name:IGIEDE, STEPHNIE
Entity type:Individual
Prefix:
First Name:STEPHNIE
Middle Name:
Last Name:IGIEDE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 PLEASANT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-3005
Mailing Address - Country:US
Mailing Address - Phone:774-357-0506
Mailing Address - Fax:508-235-1034
Practice Address - Street 1:277 PLEASANT ST STE 202
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3005
Practice Address - Country:US
Practice Address - Phone:774-357-0506
Practice Address - Fax:508-235-1034
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant