Provider Demographics
NPI:1184427908
Name:STEWART, SELENA MABEL
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:MABEL
Last Name:STEWART
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7688 SAINT PATRICK WAY UNIT 1055
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-6769
Mailing Address - Country:US
Mailing Address - Phone:214-470-8506
Mailing Address - Fax:
Practice Address - Street 1:7688 SAINT PATRICK WAY UNIT 1055
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-6769
Practice Address - Country:US
Practice Address - Phone:214-470-8506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033282363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care