Provider Demographics
NPI:1841443843
Name:SHEWPRASHAD, STACY HOLDER (DPM)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:HOLDER
Last Name:SHEWPRASHAD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1791 NW 123RD AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4383
Mailing Address - Country:US
Mailing Address - Phone:954-391-7674
Mailing Address - Fax:954-374-6958
Practice Address - Street 1:1791 NW 123RD AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4383
Practice Address - Country:US
Practice Address - Phone:954-391-7674
Practice Address - Fax:954-374-6958
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPR65213ES0103X
FLPO3583213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery