MEDICARE: STEFANIE MARIE INDELLICATI PA-C

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	363A00000X	Physician Assistant	PA9109630	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285188219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE MARIE INDELLICATI PA-C

Provider Business Mailing Address
First Line	:	4700 EXCHANGE CT STE 110
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-4450
Country	:	US
Telephone Number	:	561-964-6664
Fax Number	:	561-964-8599

Provider Business Practice Location Address
First Line	:	603 VILLAGE BLVD STE 201
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1972
Country	:	US
Telephone Number	:	561-964-6664
Fax Number	:	561-964-8599

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

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	05/01/2026

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