Provider Demographics
NPI:1700180536
Name:STEWART, TIFFANI CHERHYS (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANI
Middle Name:CHERHYS
Last Name:STEWART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4939 S DORCHESTER AVE APT 5C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-2871
Mailing Address - Country:US
Mailing Address - Phone:708-668-6850
Mailing Address - Fax:
Practice Address - Street 1:4939 S DORCHESTER AVE APT 5C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2871
Practice Address - Country:US
Practice Address - Phone:708-668-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-09
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003927363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085003927Medicaid