Healthcare Provider Details

I. General information

NPI: 1710229430
Provider Name (Legal Business Name): AMY STEPHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14428 TURNING LEAF DRIVE
ORLANDO FL
32828
US

IV. Provider business mailing address

112 CURRYS LANDING TRL
BRANDON FL
33511-8408
US

V. Phone/Fax

Practice location:
  • Phone: 321-961-3489
  • Fax:
Mailing address:
  • Phone: 281-216-8736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: