MEDICARE: DR. STEPHANIE MAURAIS DPM

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	213E00000X	Podiatrist	N006392	NY
2	213ES0103X	Foot & Ankle Surgery Podiatrist	807	NC

General Provider Information

NPI Number	:	1871895912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE MAURAIS DPM

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3641 WESTGATE CENTER CIR STE A
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-2936
Country	:	US
Telephone Number	:	336-277-6550
Fax Number	:

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

Provider Enumeration Date	:	11/22/2010
Last Update Date	:	12/29/2022

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