Healthcare Provider Details

I. General information

NPI: 1093708901
Provider Name (Legal Business Name): STEPHANIE G CULLINANE PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 MARINSHIP WAY STE 370
SAUSALITO CA
94965-2853
US

IV. Provider business mailing address

535 MILLER AVE
MILL VALLEY CA
94941-2905
US

V. Phone/Fax

Practice location:
  • Phone: 415-887-9758
  • Fax: 415-887-9763
Mailing address:
  • Phone: 415-383-5486
  • Fax: 415-389-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: