MEDICARE: STEPHNEY D. AYRES DOM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	FL9199078	FL
2	171100000X	Acupuncturist	AP3641	FL

General Provider Information

NPI Number	:	1659754562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHNEY D. AYRES DOM

Provider Business Mailing Address
First Line	:	18801 LEETANA RD
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33917-4741
Country	:	US
Telephone Number	:	239-898-0277
Fax Number	:

Provider Business Practice Location Address
First Line	:	18801 LEETANA RD
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33917-4741
Country	:	US
Telephone Number	:	239-898-0277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2015
Last Update Date	:	05/29/2020

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