=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699955989
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS D STELNICKI DPM PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2007
-----------------------------------------------------
Last Update Date | 12/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7509 STATE ROAD 52 STE 130
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-6787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-869-9559
-----------------------------------------------------
Fax | 727-869-9331
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7509 STATE ROAD 52 STE 130
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-6787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-869-9559
-----------------------------------------------------
Fax | 727-869-9331
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. THOMAS D STELNICKI
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 727-869-9559
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | PO807
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------