Healthcare Provider Details

I. General information

NPI: 1366126237
Provider Name (Legal Business Name): STEPHANIE NOCEDA GALT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE NOCEDA MD

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13403 BOYETTE RD
RIVERVIEW FL
33569-8742
US

IV. Provider business mailing address

13403 BOYETTE RD
RIVERVIEW FL
33569-8742
US

V. Phone/Fax

Practice location:
  • Phone: 813-467-4711
  • Fax:
Mailing address:
  • Phone: 813-467-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number180760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: