Provider Demographics
NPI:1265624571
Name:CUDJOE, STEPHANIE LEE-BLANCHE (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LEE-BLANCHE
Last Name:CUDJOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8951 COLLIN MCKINNEY PKWY STE 502
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8482
Mailing Address - Country:US
Mailing Address - Phone:972-214-8579
Mailing Address - Fax:972-947-5284
Practice Address - Street 1:8951 COLLIN MCKINNEY PKWY STE 502
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-8482
Practice Address - Country:US
Practice Address - Phone:972-214-8579
Practice Address - Fax:972-947-5284
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9942207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F8839OtherBCBS
TX197529401Medicaid
TX8F8839OtherBCBS