Healthcare Provider Details

I. General information

NPI: 1467625079
Provider Name (Legal Business Name): STEPHENIE R. FLEEGLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SPYGLASS CT STE 501
VIERA FL
32940-8747
US

IV. Provider business mailing address

7000 SPYGLASS CT STE 501
VIERA FL
32940-8747
US

V. Phone/Fax

Practice location:
  • Phone: 321-247-7063
  • Fax:
Mailing address:
  • Phone: 321-247-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA126389
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME171531
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD-16664
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: