Healthcare Provider Details

I. General information

NPI: 1215688288
Provider Name (Legal Business Name): STEPHANIE MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 SW 10TH PL APT 105
DEERFIELD BEACH FL
33442-8338
US

IV. Provider business mailing address

4371 SW 10TH PL APT 105
DEERFIELD BEACH FL
33442-8338
US

V. Phone/Fax

Practice location:
  • Phone: 201-565-6228
  • Fax:
Mailing address:
  • Phone: 201-565-6228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: