Provider Demographics
NPI:1043785959
Name:HELMINIAK, STEPHANIE ANDREA (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANDREA
Last Name:HELMINIAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19608 GAUKLER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3352
Mailing Address - Country:US
Mailing Address - Phone:586-879-8165
Mailing Address - Fax:
Practice Address - Street 1:2915 WALTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1419
Practice Address - Country:US
Practice Address - Phone:248-759-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-06
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008862363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical