Provider Demographics
NPI:1891958898
Name:STEVENS, CAROL MELINDA (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:MELINDA
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4868
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13221
Mailing Address - Country:US
Mailing Address - Phone:315-452-2500
Mailing Address - Fax:315-452-2510
Practice Address - Street 1:5100 W TAFT RD STE 1C
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3808
Practice Address - Country:US
Practice Address - Phone:315-634-3399
Practice Address - Fax:315-634-3481
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271807208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery