MEDICARE: PHILLIP 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	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326791419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP STEWART

Provider Business Mailing Address
First Line	:	1308 AVON LN APT 25
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-5940
Country	:	US
Telephone Number	:	786-526-9526
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 AVON LN APT 25
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-5940
Country	:	US
Telephone Number	:	786-526-9526
Fax Number	:

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

Provider Enumeration Date	:	01/31/2022
Last Update Date	:	01/31/2022

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Directions to “ PHILLIP STEWART ” Practice Location

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