Healthcare Provider Details

I. General information

NPI: 1770326217
Provider Name (Legal Business Name): STEPHANIE MICHELLE SEKUNNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 DUNN AVE
DAYTONA BEACH FL
32114-2405
US

IV. Provider business mailing address

553 S LANVALE AVE
DAYTONA BEACH FL
32114-3942
US

V. Phone/Fax

Practice location:
  • Phone: 386-255-4568
  • Fax:
Mailing address:
  • Phone: 386-299-7769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: