Provider Demographics
NPI:1467086132
Name:STEWART, SYRIA
Entity Type:Individual
Prefix:
First Name:SYRIA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CENTERDALE ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-3331
Mailing Address - Country:US
Mailing Address - Phone:434-329-8173
Mailing Address - Fax:
Practice Address - Street 1:901 CENTERDALE ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-3331
Practice Address - Country:US
Practice Address - Phone:434-329-8173
Practice Address - Fax:434-616-6000
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver