MEDICARE: ALEXANDRA STAVROS APRN

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	207NP0225X	Pediatric Dermatology Physician	APRN11045296	FL

General Provider Information

NPI Number	:	1871444513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA STAVROS APRN

Provider Business Mailing Address
First Line	:	115 MARINERS GATE CT
Second Line	:
City	:	EDGEWATER
State	:	FL
Zip	:	32141-8113
Country	:	US
Telephone Number	:	630-740-1404
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 E PRINCETON ST STE 416
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-1469
Country	:	US
Telephone Number	:	630-740-1404
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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