Healthcare Provider Details

I. General information

NPI: 1225471022
Provider Name (Legal Business Name): KYLE JAY STEPHENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 08/13/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10770 N 46TH ST BLDG E
TAMPA FL
33617-3442
US

IV. Provider business mailing address

10770 N 46TH ST BLDG E
TAMPA FL
33617-3442
US

V. Phone/Fax

Practice location:
  • Phone: 813-631-7100
  • Fax: 813-631-7128
Mailing address:
  • Phone: 813-631-7100
  • Fax: 813-631-7128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME123435
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: