Healthcare Provider Details

I. General information

NPI: 1134429665
Provider Name (Legal Business Name): ALEXANDRA MAJESTY P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 SE OCEAN BLVD STE 301
STUART FL
34996-3301
US

IV. Provider business mailing address

2220 SE OCEAN BLVD STE 301
STUART FL
34996-3301
US

V. Phone/Fax

Practice location:
  • Phone: 772-220-3339
  • Fax: 772-286-2635
Mailing address:
  • Phone: 772-220-3339
  • Fax: 772-286-2635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0010-03505
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4703
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number017303
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number22939
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-03505
License Number StateNC
# 6
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9111171
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: