Individual
DR. SHARISSE MARIE STEPHENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
583 S CLARIZZ BLVD, BLOOMINGTON, IN 47401-5515
(812) 676-4460
(812) 355-4092
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
0101281179
VA
2084N0400X
Neurology Physician
Primary
01090219A
IN
2084N0400X
Neurology Physician
233320
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540887
MEDICARE PTAN
IN
05
—
300078531
—
IN
Enumeration date
10/15/2007
Last updated
10/03/2024
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