MEDICARE: STEPHANIE FIDUK FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	SP029432	PA

General Provider Information

NPI Number	:	1144076472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE FIDUK FNP

Provider Business Mailing Address
First Line	:	1608 WALNUT ST STE 1700
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-5410
Country	:	US
Telephone Number	:	215-600-0062
Fax Number	:	800-768-1738

Provider Business Practice Location Address
First Line	:	1608 WALNUT ST STE 1700
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-5410
Country	:	US
Telephone Number	:	215-600-0062
Fax Number	:	800-768-1738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2024
Last Update Date	:	01/05/2026

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