MEDICARE: DR. NICOLE D STELIOTES DMD

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	122300000X	Dentist	DN28034	FL

General Provider Information

NPI Number	:	1013697507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE D STELIOTES DMD

Provider Business Mailing Address
First Line	:	214 ABBEY BROOK LN
Second Line	:
City	:	VENETIA
State	:	PA
Zip	:	15367-1058
Country	:	US
Telephone Number	:	724-825-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2663 1ST AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33713-8703
Country	:	US
Telephone Number	:	727-332-0505
Fax Number	:

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

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	07/20/2023

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