Healthcare Provider Details

I. General information

NPI: 1639098015
Provider Name (Legal Business Name): SYNNAMON ALYSE STONE BT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 FAIRHAVEN DR
DAVENPORT FL
33837-4544
US

IV. Provider business mailing address

574 FAIRHAVEN DR
DAVENPORT FL
33837-4544
US

V. Phone/Fax

Practice location:
  • Phone: 689-241-0434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberS242-575-83-600-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: