Healthcare Provider Details

I. General information

NPI: 1104492743
Provider Name (Legal Business Name): DESTINEE STEELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/03/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7303 TWINWOOD TRCE
SANFORD FL
32771-7260
US

IV. Provider business mailing address

PO BOX 954059
LAKE MARY FL
32795-4059
US

V. Phone/Fax

Practice location:
  • Phone: 805-793-6794
  • Fax: 407-386-3119
Mailing address:
  • Phone: 805-793-6794
  • Fax: 407-386-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: