MEDICARE: MRS. STEPHANIE D SCOTT CSFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	199074	TX

General Provider Information

NPI Number	:	1548857485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE D SCOTT CSFA

Provider Business Mailing Address
First Line	:	10455 N CENTRAL EXPY, #109 PMB 125
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-2215
Country	:	US
Telephone Number	:	469-518-7853
Fax Number	:	469-232-9917

Provider Business Practice Location Address
First Line	:	1102 N GALLOWAY AVE
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-2436
Country	:	US
Telephone Number	:	469-518-7853
Fax Number	:	469-232-9917

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2020
Last Update Date	:	06/23/2022

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