MEDICARE: STEPHEN SAAVEDRA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1003355272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN SAAVEDRA

Provider Business Mailing Address
First Line	:	1758 WAPELLO AVE SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-5552
Country	:	US
Telephone Number	:	321-537-4426
Fax Number	:

Provider Business Practice Location Address
First Line	:	1758 WAPELLO AVE SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-5552
Country	:	US
Telephone Number	:	321-537-4426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	03/21/2017

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Directions to “ STEPHEN SAAVEDRA ” Practice Location

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