MEDICARE: STEPHANIE AZEVEDO 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	5439	AZ

General Provider Information

NPI Number	:	1740618800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE AZEVEDO PA-C

Provider Business Mailing Address
First Line	:	6320B W UNION HILLS DR
Second Line	:	SUITE 2300
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7201
Country	:	US
Telephone Number	:	623-561-9113
Fax Number	:

Provider Business Practice Location Address
First Line	:	6320B W UNION HILLS DR
Second Line	:	SUITE 2300
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7201
Country	:	US
Telephone Number	:	623-561-9113
Fax Number	:

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

Provider Enumeration Date	:	10/28/2013
Last Update Date	:	10/28/2013

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