Healthcare Provider Details

I. General information

NPI: 1013826858
Provider Name (Legal Business Name): STEPHANIE SIHUA TIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE TIAN

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 GARRISON RD
BROOKLINE MA
02445-4445
US

IV. Provider business mailing address

559 BOYLSTON ST
NEWTON MA
02459-2740
US

V. Phone/Fax

Practice location:
  • Phone: 617-277-8107
  • Fax:
Mailing address:
  • Phone: 617-678-4165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: