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General NPI Number Information
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NPI Number | 1194015040
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Entity Type | Individual
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Provider Name | STEPHANIE BUTTACCIO AP, DOM
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Gender | Female
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 950 N COURTENAY PKWY STE 1
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-4501
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Country | US
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Telephone | 321-453-2844
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Fax | 321-452-6452
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Provider Business Mailing Address
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Address Line | 3060 N ATLANTIC AVE APT 401
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City | COCOA BEACH
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State | FL
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Zip | 32931-5046
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Country | US
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Telephone | 585-905-1553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP 2578
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License Number State | FL
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