Provider Demographics
NPI:1164783858
Name:STERN, ALEXANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:
Last Name:STERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:WIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:86 W UNDERWOOD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1110
Mailing Address - Country:US
Mailing Address - Phone:407-649-6876
Mailing Address - Fax:407-872-0544
Practice Address - Street 1:86 W UNDERWOOD ST STE 202
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1110
Practice Address - Country:US
Practice Address - Phone:407-649-6876
Practice Address - Fax:407-872-0544
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN17556390200000X
FLME122141208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015337200Medicaid
FL015337200Medicaid