Healthcare Provider Details

I. General information

NPI: 1386130698
Provider Name (Legal Business Name): STELLA CHANG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11235 US HIGHWAY 301 N
PARRISH FL
34219-8705
US

IV. Provider business mailing address

11235 US HIGHWAY 301 N
PARRISH FL
34219-8705
US

V. Phone/Fax

Practice location:
  • Phone: 941-776-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: