Healthcare Provider Details

I. General information

NPI: 1902748338
Provider Name (Legal Business Name): DYLAN MATTHEW STEVENS CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 FERNCROFT RD
DANVERS MA
01923-4017
US

IV. Provider business mailing address

5 PARADISE RD
BEVERLY MA
01915-2017
US

V. Phone/Fax

Practice location:
  • Phone: 978-677-1483
  • Fax:
Mailing address:
  • Phone: 978-501-2232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: