MEDICARE: MRS. DARYA ROBERTA STEWART PA-C

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	363A00000X	Physician Assistant	PA19787	CA
2	363AM0700X	Medical Physician Assistant	MA057122	PA

General Provider Information

NPI Number	:	1346498565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DARYA ROBERTA STEWART PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1754
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18105-1754
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6451 VILLAGE LN
Second Line	:
City	:	MACUNGIE
State	:	PA
Zip	:	18062-8484
Country	:	US
Telephone Number	:	610-967-2772
Fax Number	:

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

Provider Enumeration Date	:	08/29/2008
Last Update Date	:	07/15/2015

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