Healthcare Provider Details

I. General information

NPI: 1760311740
Provider Name (Legal Business Name): STEPHANIE T LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14575 NE 21ST ST LOT E01
SILVER SPGS FL
34488-8410
US

IV. Provider business mailing address

14575 NE 21ST ST LOT E01
SILVER SPGS FL
34488-8410
US

V. Phone/Fax

Practice location:
  • Phone: 561-247-2555
  • Fax:
Mailing address:
  • Phone: 561-247-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCL1290056
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: