MEDICARE: DR. SANDRA REBECCA STEPHENS DO

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	208D00000X	General Practice Physician	OS6988	FL
2	207Q00000X	Family Medicine Physician	OS6988	FL

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	:	1831126051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA REBECCA STEPHENS DO

Provider Business Mailing Address
First Line	:	97336 PIRATES POINT RD
Second Line	:
City	:	YULEE
State	:	FL
Zip	:	32097-1404
Country	:	US
Telephone Number	:	904-200-2065
Fax Number	:

Provider Business Practice Location Address
First Line	:	22385 FLORA PARKE XING
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-8000
Country	:	US
Telephone Number	:	904-404-8641
Fax Number	:	904-227-3246

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	03/03/2025

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