Healthcare Provider Details

I. General information

NPI: 1518240472
Provider Name (Legal Business Name): STEPHEN V. GUIDA, DPMPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 11/24/2023
Certification Date: 11/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 NE 20TH TER STE 209D
FT LAUDERDALE FL
33308
US

IV. Provider business mailing address

4800 NE 20TH TER STE 209D
FT LAUDERDALE FL
33308
US

V. Phone/Fax

Practice location:
  • Phone: 954-776-1612
  • Fax: 954-776-1699
Mailing address:
  • Phone: 954-776-1612
  • Fax: 954-776-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2047
License Number StateFL

VIII. Authorized Official

Name: VICKY F HARKINS
Title or Position: BILLING MANAGER
Credential: RMC
Phone: 800-503-1375