Healthcare Provider Details

I. General information

NPI: 1952033136
Provider Name (Legal Business Name): STEPHANY ALFONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HOMESTEAD RD N STE 41
LEHIGH ACRES FL
33936-6600
US

IV. Provider business mailing address

647 NIMITZ BLVD
LEHIGH ACRES FL
33974-5716
US

V. Phone/Fax

Practice location:
  • Phone: 239-888-0561
  • Fax:
Mailing address:
  • Phone: 786-848-9813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: