MEDICARE: STT MEDICAL PLLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1548925993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STT MEDICAL PLLC

Provider Business Mailing Address
First Line	:	6972 SOLOMON AVE
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-1290
Country	:	US
Telephone Number	:	313-258-7335
Fax Number	:

Provider Business Practice Location Address
First Line	:	8565 N SILVERY LN STE 100
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-4517
Country	:	US
Telephone Number	:	313-258-7335
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STACEY TERRELL TAYLOR
Credential	:	MSN, APRN, FNP-C
Telephone Number	:	313-258-7335

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	11/01/2021

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Directions to “STT MEDICAL PLLC ” Practice Location

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