Healthcare Provider Details

I. General information

NPI: 1174614663
Provider Name (Legal Business Name): STEPHEN H HORNELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E SHERIDAN RD
MELBOURNE FL
32901-3152
US

IV. Provider business mailing address

333 E SHERIDAN RD
MELBOURNE FL
32901-3152
US

V. Phone/Fax

Practice location:
  • Phone: 321-724-9650
  • Fax: 321-724-2643
Mailing address:
  • Phone: 321-724-9650
  • Fax: 321-724-2643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME0024691
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME0024691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: