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General NPI Number Information
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NPI Number | 1588951057
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Entity Type | Individual
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Provider Name | STEPHEN DANIEL DECARLO PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/06/2011
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 1011 CROSS CUT WAY
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City | LONGWOOD
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State | FL
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Zip | 32750-3078
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Country | US
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Telephone | 407-461-2560
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Fax |
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Provider Business Mailing Address
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Address Line | 4563 MOUNTAIN RD
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City | PASADENA
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State | MD
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Zip | 21122-5326
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Country | US
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Telephone | 407-461-2560
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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