Healthcare Provider Details

I. General information

NPI: 1174255640
Provider Name (Legal Business Name): STEFANO GATTAZZO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BENMORE DR STE 200
WINTER PARK FL
32792-4111
US

IV. Provider business mailing address

133 BENMORE DR STE 200
WINTER PARK FL
32792-4111
US

V. Phone/Fax

Practice location:
  • Phone: 407-599-6060
  • Fax:
Mailing address:
  • Phone: 407-599-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME178519
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: