Healthcare Provider Details

I. General information

NPI: 1902068570
Provider Name (Legal Business Name): SHELBY JA'MEL STEWART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

306 W REDWOOD ST FL 4
BALTIMORE MD
21201-1708
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6366
  • Fax:
Mailing address:
  • Phone: 667-214-1720
  • Fax: 410-706-6976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT193357
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD82245
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberD82245
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: