Provider Demographics
NPI:1629537329
Name:STEWART, SYREETA
Entity Type:Individual
Prefix:MS
First Name:SYREETA
Middle Name:
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 1:2436 N FEDERAL HWY # 347
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6854
Mailing Address - Country:US
Mailing Address - Phone:516-423-0925
Mailing Address - Fax:
Practice Address - Street 1:3808 CRYSTAL LAKE DR APT 211
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1356
Practice Address - Country:US
Practice Address - Phone:516-423-0925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor