Healthcare Provider Details

I. General information

NPI: 1750839791
Provider Name (Legal Business Name): WHITNEY BEAN STEWART PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38B GROVE ST SUITE 1B
RIDGEFIELD CT
06877-4665
US

IV. Provider business mailing address

38B GROVE ST SUITE 1B
RIDGEFIELD CT
06877-4665
US

V. Phone/Fax

Practice location:
  • Phone: 203-438-9557
  • Fax: 203-438-6456
Mailing address:
  • Phone: 203-438-9557
  • Fax: 203-438-6456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003643
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number003643
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: