Provider Demographics
NPI:1780192633
Name:CYRIAQUE, STEPHANE (FNP)
Entity Type:Individual
Prefix:
First Name:STEPHANE
Middle Name:
Last Name:CYRIAQUE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 TEXAS PKWY UNIT B
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-5242
Mailing Address - Country:US
Mailing Address - Phone:346-374-8402
Mailing Address - Fax:346-374-7434
Practice Address - Street 1:3003 TEXAS PKWY UNIT B
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-5242
Practice Address - Country:US
Practice Address - Phone:346-374-8402
Practice Address - Fax:346-374-7434
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily