Provider Demographics
NPI:1891915724
Name:STEWART, SHEILA (CERTIFIED)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6918 REAL PRINCESS LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4578
Mailing Address - Country:US
Mailing Address - Phone:410-281-7839
Mailing Address - Fax:410-281-7839
Practice Address - Street 1:9 W FRONT ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2816
Practice Address - Country:US
Practice Address - Phone:180-087-7822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD246RP1900X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD246RP1900XOther06-002Y86