Healthcare Provider Details

I. General information

NPI: 1639732035
Provider Name (Legal Business Name): STEPHANIE JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST # 9C
DETROIT MI
48201-2153
US

IV. Provider business mailing address

2601 RED HIBISCUS BLVD APT 103
DELRAY BEACH FL
33445-6110
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-5009
  • Fax: 313-577-5310
Mailing address:
  • Phone:
  • 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: