Provider Demographics
NPI:1568039949
Name:SAN GIOVANNI, STEPHANIE (PA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SAN GIOVANNI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ROUTE 6A
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-1771
Mailing Address - Country:US
Mailing Address - Phone:508-771-9550
Mailing Address - Fax:
Practice Address - Street 1:125 ROUTE 6A
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-1771
Practice Address - Country:US
Practice Address - Phone:508-771-9550
Practice Address - Fax:508-790-9304
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-05
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1183442363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant