Provider Demographics
NPI:1538103627
Name:STEWART, STEPHANIE DEAKIN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DEAKIN
Last Name:STEWART
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:99 EAST RIVER DRIVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108
Mailing Address - Country:US
Mailing Address - Phone:860-282-0833
Mailing Address - Fax:
Practice Address - Street 1:100 GREAT MEADOW RD
Practice Address - Street 2:SUITE 208
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2355
Practice Address - Country:US
Practice Address - Phone:860-563-0700
Practice Address - Fax:860-563-0741
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003211367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered