Healthcare Provider Details

I. General information

NPI: 1194105668
Provider Name (Legal Business Name): STEPHANIE ANN CIMO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2015
Last Update Date: 04/25/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 NAPOLEON AVE
NEW ORLEANS LA
70115-6914
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 504-899-9311
  • Fax:
Mailing address:
  • Phone: 504-842-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number61384
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number335173
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: