Provider Demographics
NPI:1881189009
Name:BELLANDE, STEPHAN PAUL
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:PAUL
Last Name:BELLANDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1292 NE MOUNT OLYMPUS LN APT B303
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3893
Mailing Address - Country:US
Mailing Address - Phone:360-701-1851
Mailing Address - Fax:
Practice Address - Street 1:1292 NE MOUNT OLYMPUS LN APT B303
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3893
Practice Address - Country:US
Practice Address - Phone:360-701-1851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600476302081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine