Healthcare Provider Details

I. General information

NPI: 1427583681
Provider Name (Legal Business Name): STEPHANIE LEVERENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4917 ELI ST
ORLANDO FL
32804-1717
US

IV. Provider business mailing address

6953 UNIVERSITY BLVD
WINTER PARK FL
32792-6710
US

V. Phone/Fax

Practice location:
  • Phone: 407-808-7837
  • Fax: 407-630-8805
Mailing address:
  • Phone: 407-543-8356
  • Fax: 407-264-6443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-74804
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: