Provider Demographics
NPI:1720125024
Name:STEPHENSON, PHYLLIS AYLLEEN (MD)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:AYLLEEN
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4781 CHANDLERS FORDE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-7120
Mailing Address - Country:US
Mailing Address - Phone:941-379-0781
Mailing Address - Fax:941-379-0781
Practice Address - Street 1:4781 CHANDLERS FORDE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-7120
Practice Address - Country:US
Practice Address - Phone:941-379-0781
Practice Address - Fax:941-379-0781
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 13444207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology