Healthcare Provider Details

I. General information

NPI: 1457082737
Provider Name (Legal Business Name): STEPHEN MICHAEL MAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2022
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 PARADAS PL
ST AUGUSTINE FL
32092-3121
US

IV. Provider business mailing address

147 PARADAS PL
ST AUGUSTINE FL
32092-3121
US

V. Phone/Fax

Practice location:
  • Phone: 904-703-6261
  • Fax:
Mailing address:
  • Phone: 904-703-6261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP11018820
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: