Healthcare Provider Details

I. General information

NPI: 1821034828
Provider Name (Legal Business Name): STEPHANIE ANN CARADONNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2179 S TAMIAMI TRL SUITE 101
OSPREY FL
34229-9239
US

IV. Provider business mailing address

628 CRANE PRAIRIE WAY
OSPREY FL
34229-7812
US

V. Phone/Fax

Practice location:
  • Phone: 941-966-0222
  • Fax: 941-966-5100
Mailing address:
  • Phone: 941-966-2310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME87302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: