Provider Demographics
NPI:1366703340
Name:MOSS, STEPHANIE ROYER (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROYER
Last Name:MOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:C
Other - Last Name:ROYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9500 EUCLID AVE # S1-20
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-217-2805
Mailing Address - Fax:216-636-3363
Practice Address - Street 1:9500 EUCLID AVE # S1-20
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-217-2805
Practice Address - Fax:216-636-3363
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.128331207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine