Provider Demographics
NPI:1073219028
Name:STEPANOV, JOSHUA RION
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RION
Last Name:STEPANOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 SHELBYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-4338
Mailing Address - Country:US
Mailing Address - Phone:931-639-8394
Mailing Address - Fax:
Practice Address - Street 1:915 SHELBYVIEW DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-4338
Practice Address - Country:US
Practice Address - Phone:931-639-8394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2024-02-07
Deactivation Date:2024-01-06
Deactivation Code:
Reactivation Date:2024-02-01
Provider Licenses
StateLicense IDTaxonomies
TN133523600172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver