Provider Demographics
NPI:1073730800
Name:YOUNG-AZAN, STEPHANIE DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:DAWN
Last Name:YOUNG-AZAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 W OAKLAND PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6925
Mailing Address - Country:US
Mailing Address - Phone:954-746-5200
Mailing Address - Fax:
Practice Address - Street 1:10001 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6925
Practice Address - Country:US
Practice Address - Phone:954-746-5200
Practice Address - Fax:954-746-5217
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00578582084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374482500Medicaid