Provider Demographics
NPI:1770877219
Name:O'NEAL, STEPHANIE (CST, CSFA, RFA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:CST, CSFA, RFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7324 SOUTHWEST FWY
Mailing Address - Street 2:STE 1550
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2012
Mailing Address - Country:US
Mailing Address - Phone:832-804-8702
Mailing Address - Fax:832-804-8802
Practice Address - Street 1:7324 SOUTHWEST FWY
Practice Address - Street 2:STE 1550
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2012
Practice Address - Country:US
Practice Address - Phone:832-804-8702
Practice Address - Fax:832-804-8802
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000293246ZC0007X
246ZS0410X
IL238.000293363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist