Healthcare Provider Details

I. General information

NPI: 1528063112
Provider Name (Legal Business Name): STEPHEN HOWARD MANDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 S KANNER HWY
STUART FL
34994-4622
US

IV. Provider business mailing address

900 VILLAGE SQUARE XING STE 290
PALM BEACH GARDENS FL
33410-4552
US

V. Phone/Fax

Practice location:
  • Phone: 772-219-2777
  • Fax: 772-219-0017
Mailing address:
  • Phone: 239-313-2517
  • Fax: 239-666-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME12999
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: