MEDICARE: STEPHANOR CORIOLAN

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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1750917464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANOR CORIOLAN

Provider Business Mailing Address
First Line	:	729 SHERWOOD TERRACE DR APT 105
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-7404
Country	:	US
Telephone Number	:	561-618-6881
Fax Number	:

Provider Business Practice Location Address
First Line	:	729 SHERWOOD TERRACE DR APT 105
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-7404
Country	:	US
Telephone Number	:	561-618-6881
Fax Number	:

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

Provider Enumeration Date	:	03/14/2020
Last Update Date	:	03/14/2020

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Directions to “ STEPHANOR CORIOLAN ” Practice Location

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