Provider Demographics
NPI:1962666784
Name:SEIXAS-MIKELUS, STEFANIE A (MD)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:A
Last Name:SEIXAS-MIKELUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 JACK MARTIN BLVD, SUITE # 304
Mailing Address - Street 2:ATLANTIC COAST UROLOGY
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723
Mailing Address - Country:US
Mailing Address - Phone:732-840-6606
Mailing Address - Fax:732-840-6601
Practice Address - Street 1:874 WHIPPLE RD STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8900
Practice Address - Country:US
Practice Address - Phone:843-981-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15266208800000X
NY253676208800000X
MA248455208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM1549OtherMEDICARE
MAM1549OtherMEDICARE