Healthcare Provider Details

I. General information

NPI: 1578198131
Provider Name (Legal Business Name): STEPHANIE SANDRA MOSES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ALTAMONTE DR
ALTAMONTE SPRINGS FL
32701-4802
US

IV. Provider business mailing address

3208 E COLONIAL DR UNIT 299
ORLANDO FL
32803-5127
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: