Healthcare Provider Details

I. General information

NPI: 1699188011
Provider Name (Legal Business Name): TATYANA STEPANENKO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 VETERANS PARK DR STE 101
NAPLES FL
34109-0447
US

IV. Provider business mailing address

1865 VETERANS PARK DR STE 101
NAPLES FL
34109-0447
US

V. Phone/Fax

Practice location:
  • Phone: 239-254-7778
  • Fax: 855-959-1692
Mailing address:
  • Phone: 239-254-7778
  • Fax: 855-959-1692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME 124535
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME 124535
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME 124535
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME 124535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: