Provider Demographics
NPI:1649419565
Name:JAZAYRI-BILLIE, STEPHANIE TARANEH (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TARANEH
Last Name:JAZAYRI-BILLIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4411 BEE RIDGE RD,
Mailing Address - Street 2:PMB 309
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2514
Mailing Address - Country:US
Mailing Address - Phone:941-234-6388
Mailing Address - Fax:941-926-8501
Practice Address - Street 1:925 NE 30TH TER STE 308
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7614
Practice Address - Country:US
Practice Address - Phone:941-926-6553
Practice Address - Fax:941-296-8501
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA 9104819363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical