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NPI Code Detail

MEDICARE: STEPHANY HERNDON NYSTRAND MT-BC

MEDICARE: STEPHANY HERNDON NYSTRAND MT-BC
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
1225A00000XMusic Therapist08591
2171W00000XContractor08591FL

General Provider Information

NPI Number : 1790650059
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANY HERNDON NYSTRAND MT-BC
Provider Business Mailing Address
First Line : 1862 NEWMAN LN
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32312-4223
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1700 N MERIDIAN RD
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32303-5646
Country : US
Telephone Number : 229-400-0722
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2025
Last Update Date : 10/07/2025

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