Healthcare Provider Details

I. General information

NPI: 1720157696
Provider Name (Legal Business Name): STEPHEN HORNELL, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
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 NumberME85500
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME89667
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME0024691
License Number StateFL

VIII. Authorized Official

Name: DR. STEPHEN H HORNELL
Title or Position: PRESIDENT
Credential: MD
Phone: 321-724-9650