Healthcare Provider Details

I. General information

NPI: 1811979925
Provider Name (Legal Business Name): STEFANO TRAVAGLINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 UNIVERSITY BLVD S SUITE 301
JACKSONVILLE FL
32216-4246
US

IV. Provider business mailing address

915 W MONROE ST SUITE 200
JACKSONVILLE FL
32204-1177
US

V. Phone/Fax

Practice location:
  • Phone: 904-384-2240
  • Fax: 904-384-6055
Mailing address:
  • Phone: 904-384-2240
  • Fax: 904-384-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME92296
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number281691
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: