Healthcare Provider Details

I. General information

NPI: 1477049955
Provider Name (Legal Business Name): FELICE DE STEFANO HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2018
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 SE 3RD AVE STE 610
FORT LAUDERDALE FL
33316-2521
US

IV. Provider business mailing address

1700 NW 49TH ST STE 125
FORT LAUDERDALE FL
33309-3750
US

V. Phone/Fax

Practice location:
  • Phone: 954-463-3131
  • Fax: 954-888-3731
Mailing address:
  • Phone: 954-463-3131
  • Fax: 954-888-3731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME166384
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: