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General NPI Number Information
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NPI Number | 1447671326
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Entity Type | Organization
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Legal Business Name | STACY HOLDER DPM PA
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Dates
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Enumeration Date | 12/19/2013
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 1791 NW 123RD AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4383
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Country | US
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Telephone | 954-391-7674
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Fax | 954-374-6958
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Provider Business Mailing Address
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Address Line | 1791 NW 123RD AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4383
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Country | US
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Telephone | 954-391-7674
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Fax | 954-374-6958
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Authorized Official
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Title or Position | OWNER
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Name | DR. STACY HOLDER SHEWPRASHAD
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Credential | D.P.M.
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Telephone | 954-391-7674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3583
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License Number State | FL
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