Provider Demographics
NPI:1548857485
Name:SCOTT, STEPHANIE D (CSFA)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:D
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10455 N CENTRAL EXPY, #109 PMB 125
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2215
Mailing Address - Country:US
Mailing Address - Phone:469-518-7853
Mailing Address - Fax:469-232-9917
Practice Address - Street 1:1102 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2436
Practice Address - Country:US
Practice Address - Phone:469-518-7853
Practice Address - Fax:469-232-9917
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-27
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX199074246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant