=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720157696
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEPHEN HORNELL, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 E SHERIDAN RD
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32901-3152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-724-9650
-----------------------------------------------------
Fax | 321-724-2643
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 E SHERIDAN RD
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32901-3152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-724-9650
-----------------------------------------------------
Fax | 321-724-2643
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEPHEN H HORNELL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 321-724-9650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | ME85500
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | ME89667
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | ME0024691
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------