Provider Demographics
NPI:1194181933
Name:STEPHENS, SYCERIA TYESHA-MICHELLE (APC-C)
Entity Type:Individual
Prefix:
First Name:SYCERIA
Middle Name:TYESHA-MICHELLE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:APC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8519
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-8519
Mailing Address - Country:US
Mailing Address - Phone:732-460-9840
Mailing Address - Fax:732-460-9848
Practice Address - Street 1:30 SHREWSBURY PLZ
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4322
Practice Address - Country:US
Practice Address - Phone:732-542-0002
Practice Address - Fax:732-542-2992
Is Sole Proprietor?:No
Enumeration Date:2016-01-09
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00591100363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily