Provider Demographics
NPI:1962727883
Name:CROSSEN, STEPHANIE SHELTON (MD, MPH)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SHELTON
Last Name:CROSSEN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 STOCKTON BLVD
Mailing Address - Street 2:STE 384
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2208
Mailing Address - Country:US
Mailing Address - Phone:916-734-7098
Mailing Address - Fax:916-734-7070
Practice Address - Street 1:2516 STOCKTON BLVD
Practice Address - Street 2:STE 384
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2208
Practice Address - Country:US
Practice Address - Phone:916-734-7098
Practice Address - Fax:916-734-7070
Is Sole Proprietor?:No
Enumeration Date:2010-04-03
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA 125418208000000X
CAA1254182080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208000000XAllopathic & Osteopathic PhysiciansPediatrics