Healthcare Provider Details

I. General information

NPI: 1922928035
Provider Name (Legal Business Name): ANTHONYA V STEWART RPT(AMT)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11629 HEREFORDSHIRE DR
SAINT LOUIS MO
63138-3536
US

IV. Provider business mailing address

11629 HEREFORDSHIRE DR
SAINT LOUIS MO
63138-3536
US

V. Phone/Fax

Practice location:
  • Phone: 314-619-3764
  • Fax:
Mailing address:
  • Phone: 314-619-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: