Provider Demographics
NPI:1093708901
Name:CULLINANE, STEPHANIE G (PA C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:G
Last Name:CULLINANE
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:535 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2905
Mailing Address - Country:US
Mailing Address - Phone:415-383-5486
Mailing Address - Fax:415-389-7455
Practice Address - Street 1:2330 MARINSHIP WAY STE 370
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2853
Practice Address - Country:US
Practice Address - Phone:415-887-9758
Practice Address - Fax:415-887-9763
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA15353363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA153530Medicare ID - Type Unspecified