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General NPI Number Information
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NPI Number | 1003225194
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Entity Type | Individual
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Provider Name | MICHELLE STEWART PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 08/04/2014
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Provider Practice Location Address
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Address Line | 600 NORTHERN BLVD SUITE 300
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City | GREAT NECK
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State | NY
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Zip | 11021-5206
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Country | US
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Telephone | 516-627-8717
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Fax |
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Provider Business Mailing Address
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Address Line | 1456 31ST DR APT 4H
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City | ASTORIA
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State | NY
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Zip | 11106-4569
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Country | US
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Telephone | 631-897-9922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 017815
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License Number State | NY
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