Healthcare Provider Details

I. General information

NPI: 1053255513
Provider Name (Legal Business Name): GRACY STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 W INDIAN SCHOOL RD STE 105
PHOENIX AZ
85037-2385
US

IV. Provider business mailing address

945 N CENTRAL AVE
WOODMERE NY
11598-1604
US

V. Phone/Fax

Practice location:
  • Phone: 520-231-7380
  • Fax:
Mailing address:
  • Phone: 516-206-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: