Healthcare Provider Details

I. General information

NPI: 1740544956
Provider Name (Legal Business Name): STEPHANIE N. LASKY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 SHERIDAN STREET S. 101
HOLLYWOOD FL
33021
US

IV. Provider business mailing address

4340 SHERIDAN STREET S. 101
HOLLYWOOD FL
33021
US

V. Phone/Fax

Practice location:
  • Phone: 954-983-5533
  • Fax:
Mailing address:
  • Phone: 954-983-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS-149238
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: