MEDICARE: ANTWAN STEWART

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	172A00000X	Driver

General Provider Information

NPI Number	:	1275236655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTWAN STEWART

Provider Business Mailing Address
First Line	:	2363 GRAND AVE APT 22A3
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-3127
Country	:	US
Telephone Number	:	516-445-0690
Fax Number	:

Provider Business Practice Location Address
First Line	:	2363 GRAND AVE APT 22A3
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-3127
Country	:	US
Telephone Number	:	516-445-0690
Fax Number	:

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

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	03/23/2023

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Directions to “ ANTWAN STEWART ” Practice Location

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