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General NPI Number Information
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NPI Number | 1902475288
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Entity Type | Individual
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Provider Name | STELLA HEREDIA MD
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Gender | Female
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 509 CAGAN VIEW RD
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City | CLERMONT
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State | FL
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Zip | 34714-6405
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Country | US
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Telephone | 407-905-8827
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Fax |
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Provider Business Mailing Address
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Address Line | 110 S WOODLAND ST
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City | WINTER GARDEN
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State | FL
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Zip | 34787-3546
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Country | US
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Telephone | 407-905-8827
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Fax | 321-221-9454
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 22443
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN1393
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License Number State | FL
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