MEDICARE: SCHILLENA STEPHENS

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	372600000X	Adult Companion
2	251E00000X	Home Health Agency
3	101YM0800X	Mental Health Counselor	MH22921	FL
4	261QD1600X	Developmental Disabilities Clinic/Center
5	385H00000X	Respite Care
6	385HR2065X	Child Physical Disabilities Respite Care

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	:	1689220824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCHILLENA STEPHENS

Provider Business Mailing Address
First Line	:	4481 SW NEW CT
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-5458
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 SW PORT ST LUCIE BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-2845
Country	:	US
Telephone Number	:	772-873-8811
Fax Number	:

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

Provider Enumeration Date	:	08/14/2019
Last Update Date	:	03/19/2026

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Directions to “ SCHILLENA STEPHENS ” Practice Location

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