Provider Demographics
NPI:1558855882
Name:STEWART, PHALANA DEMETRI
Entity Type:Individual
Prefix:MS
First Name:PHALANA
Middle Name:DEMETRI
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 1:328 RICE AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44704-2150
Mailing Address - Country:US
Mailing Address - Phone:330-949-0060
Mailing Address - Fax:
Practice Address - Street 1:5860 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-1752
Practice Address - Country:US
Practice Address - Phone:330-949-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator