Healthcare Provider Details

I. General information

NPI: 1528065521
Provider Name (Legal Business Name): STEFANIE ALIDA SCHULTIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LAKEVIEW DR SUITE 100
COVINGTON LA
70433-7509
US

IV. Provider business mailing address

110 LAKEVIEW DR SUITE 100
COVINGTON LA
70433-7509
US

V. Phone/Fax

Practice location:
  • Phone: 985-898-1940
  • Fax: 985-893-3427
Mailing address:
  • Phone: 985-898-1940
  • Fax: 985-893-3427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number018419
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: