Healthcare Provider Details

I. General information

NPI: 1386312197
Provider Name (Legal Business Name): CORINNE STYPULKOSKI MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2021
Last Update Date: 09/06/2021
Certification Date: 09/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 PORTOFINO WAY APT 203
WEST PALM BEACH FL
33409-7894
US

IV. Provider business mailing address

14539 SUNDIAL PL
LAKEWOOD RANCH FL
34202-5895
US

V. Phone/Fax

Practice location:
  • Phone: 561-290-2941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number13366
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: