Healthcare Provider Details

I. General information

NPI: 1437941341
Provider Name (Legal Business Name): M D DEVELOPMENTAL AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 SAINT ROSE PKWY # H2-216
HENDERSON NV
89074-7783
US

IV. Provider business mailing address

2520 SAINT ROSE PKWY # H2-216
HENDERSON NV
89074-7783
US

V. Phone/Fax

Practice location:
  • Phone: 702-268-8513
  • Fax: 702-852-0430
Mailing address:
  • Phone: 702-268-8513
  • Fax: 702-852-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DEBRA STEWART
Title or Position: CO-OWNER
Credential:
Phone: 773-407-7558