Provider Demographics
NPI:1568658037
Name:STEVENS, SUELLEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:SUELLEN
Middle Name:E
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 STONEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-0952
Mailing Address - Country:US
Mailing Address - Phone:502-551-5703
Mailing Address - Fax:
Practice Address - Street 1:1050 NORTHGATE DR STE 550
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2543
Practice Address - Country:US
Practice Address - Phone:415-296-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1609082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry