Provider Demographics
NPI:1124392741
Name:SCHMIEDECKE, STACEY STEVENS (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:STEVENS
Last Name:SCHMIEDECKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:AEIRN
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:DEPT OB/GYN, DIVISION OF MFM
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-0001
Mailing Address - Country:US
Mailing Address - Phone:619-532-7020
Mailing Address - Fax:619-532-6378
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:DEPT OB/GYN, DIVISION OF MFM
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-0001
Practice Address - Country:US
Practice Address - Phone:619-532-7020
Practice Address - Fax:619-532-6378
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072991A207VM0101X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD0000Medicare UPIN