MEDICARE: STEPHANNY REYES MD

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	83819	CT
2	390200000X	Student in an Organized Health Care Education/Training Program		CT

General Provider Information

NPI Number	:	1992382105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANNY REYES MD

Provider Business Mailing Address
First Line	:	124 WINDRIDGE ST
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-3856
Country	:	US
Telephone Number	:	863-877-6056
Fax Number	:

Provider Business Practice Location Address
First Line	:	743 SPRING ST NE STE 710
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3715
Country	:	US
Telephone Number	:	770-219-8730
Fax Number	:

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

Provider Enumeration Date	:	03/24/2021
Last Update Date	:	02/18/2026

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