Provider Demographics
NPI:1679536932
Name:STEWART, SUELLYWN (MD)
Entity type:Individual
Prefix:
First Name:SUELLYWN
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 WOODGATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031
Mailing Address - Country:US
Mailing Address - Phone:220-564-1810
Mailing Address - Fax:220-564-1811
Practice Address - Street 1:151 WOODGATE DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031
Practice Address - Country:US
Practice Address - Phone:220-564-1810
Practice Address - Fax:220-564-1811
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2437045Medicaid
OHH124000Medicare UPIN