Healthcare Provider Details

I. General information

NPI: 1346498565
Provider Name (Legal Business Name): DARYA ROBERTA STEWART PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 VILLAGE LN
MACUNGIE PA
18062-8484
US

IV. Provider business mailing address

PO BOX 1754
ALLENTOWN PA
18105-1754
US

V. Phone/Fax

Practice location:
  • Phone: 610-967-2772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19787
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA057122
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: