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Individual
STEPHANIE D. DESANDRO
Active
Individual
STEPHANIE D. DESANDRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA03686
TX
363AM0700X
Medical Physician Assistant
PA03686
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003182516
CSHCN
TX
05
—
181497201
—
TX
01
—
8N3838
BCBS
TX
Enumeration date
07/10/2006
Last updated
08/01/2016
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