Provider Demographics
NPI:1518485895
Name:DEW, STEPHANIE E (PA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:DEW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:960 MASS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:161-741-4540
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY STREET, SUITE 4B
Practice Address - Street 2:SHAPIRO BLDG
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-5633
Practice Address - Fax:617-414-5226
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAPA8578363A00000X
MA22551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist