Provider Demographics
NPI:1497011977
Name:THARAYIL, STEPHANIE JEANNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JEANNETH
Last Name:THARAYIL
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 1:5819 HIGHWAY 6 STE 300
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4061
Mailing Address - Country:US
Mailing Address - Phone:786-277-1704
Mailing Address - Fax:281-499-0424
Practice Address - Street 1:5819 HIGHWAY 6 STE 300
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4061
Practice Address - Country:US
Practice Address - Phone:786-277-1704
Practice Address - Fax:281-499-0424
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29107208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics