Healthcare Provider Details

I. General information

NPI: 1134719602
Provider Name (Legal Business Name): STEPHANIE FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12780 WATERFORD LAKES PKWY STE 127
ORLANDO FL
32828-4501
US

IV. Provider business mailing address

1024 W RIVIERA BLVD
OVIEDO FL
32765-5633
US

V. Phone/Fax

Practice location:
  • Phone: 407-848-8083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: