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General NPI Number Information
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NPI Number | 1245868447
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Entity Type | Individual
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Provider Name | STEFANY CARVALHO DPM
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Gender | Female
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 2024 S 6TH ST
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City | BRAINERD
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State | MN
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Zip | 56401-4529
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Country | US
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Telephone | 218-828-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 1702 UNIVERSITY DR S
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City | FARGO
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State | ND
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Zip | 58103-4940
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Country | US
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Telephone | 701-364-8000
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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 | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | PD1183
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E5943
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License Number State | CA
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