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General NPI Number Information
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NPI Number | 1285408963
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Entity Type | Individual
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Provider Name | STEPHANIE ALYCE PEACOCK HAS
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Gender | Female
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 1665 DUNLAWTON AVE STE 107
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City | PORT ORANGE
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State | FL
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Zip | 32127-2920
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Country | US
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Telephone | 386-238-9069
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Fax | 689-686-6525
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Provider Business Mailing Address
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Address Line | 750 N COMMONS DR STE 200
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City | AURORA
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State | IL
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Zip | 60504-8025
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Country | US
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Telephone | 630-303-5380
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Fax | 630-303-5385
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | AS5770
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License Number State | FL
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