Provider Demographics
NPI:1417748781
Name:M D DEVELOPMENTAL AGENCY LLC
Entity type:Organization
Organization Name:M D DEVELOPMENTAL AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-407-7558
Mailing Address - Street 1:2520 SAINT ROSE PKWY STE H2-216
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7783
Mailing Address - Country:US
Mailing Address - Phone:702-268-8513
Mailing Address - Fax:702-852-0430
Practice Address - Street 1:2520 SAINT ROSE PKWY # H2-216
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7783
Practice Address - Country:US
Practice Address - Phone:702-268-8513
Practice Address - Fax:702-852-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty