Provider Demographics
NPI:1508477829
Name:STEWART, CICELY
Entity Type:Individual
Prefix:MISS
First Name:CICELY
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 1:1839 BANCROFT DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23663-2025
Mailing Address - Country:US
Mailing Address - Phone:757-637-0084
Mailing Address - Fax:
Practice Address - Street 1:751 THIMBLE SHOALS BLVD STE I
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3563
Practice Address - Country:US
Practice Address - Phone:757-637-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508477829OtherBIRTH DOULA, POSTPARTUM DOULA