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General NPI Number Information
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NPI Number | 1104020635
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Entity Type | Individual
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Provider Name | SHELLY ANN STEPENASKIE MD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 1001 WOODWARD PL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2705
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Country | US
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Telephone | 505-938-8296
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Fax | 505-938-8688
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Provider Business Mailing Address
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Address Line | 800 BRADBURY DR SE STE 116
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4310
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Country | US
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Telephone | 505-272-1476
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Fax | 505-938-8688
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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 | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | MD 2009-0256
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | M6465
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 45585
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License Number State | AZ
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