Healthcare Provider Details

I. General information

NPI: 1174808059
Provider Name (Legal Business Name): STEPHANIE E HARRIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CONNECTICUT AVE NW SUITE 1250
WASHINGTON DC
20036-1722
US

IV. Provider business mailing address

1350 CONNECTICUT AVE NW SUITE 1250
WASHINGTON DC
20036-1722
US

V. Phone/Fax

Practice location:
  • Phone: 202-627-1901
  • Fax: 415-252-7176
Mailing address:
  • Phone: 202-627-1901
  • Fax: 202-660-0025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA030791
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9863
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: