Provider Demographics
NPI:1750329777
Name:AMSTADTER, STEPHANI J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANI
Middle Name:J
Last Name:AMSTADTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 116TH AVE NE
Mailing Address - Street 2:STE 102
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3055
Mailing Address - Country:US
Mailing Address - Phone:253-584-3023
Mailing Address - Fax:253-582-1222
Practice Address - Street 1:5920 - 100TH ST. SW #31
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2751
Practice Address - Country:US
Practice Address - Phone:253-584-3023
Practice Address - Fax:253-582-1222
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY241321-1207PE0004X
WAMD60031114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAH99704Medicare UPIN