Provider Demographics
NPI:1518125509
Name:JARDELEZA, MARIA STEPHANIE R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA STEPHANIE
Middle Name:R
Last Name:JARDELEZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4414 LAKE BOONE TRL STE 302
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7514
Mailing Address - Country:US
Mailing Address - Phone:919-782-8038
Mailing Address - Fax:919-782-8189
Practice Address - Street 1:4414 LAKE BOONE TRL STE 302
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7514
Practice Address - Country:US
Practice Address - Phone:919-782-8038
Practice Address - Fax:919-782-8189
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-02971207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280101102OtherCSHCN
TX2801011-03Medicaid
TX280101101Medicaid
TX555153YSNRMedicare PIN
TX280101102OtherCSHCN