1245786946 NPI number — STEPHANIE MARIE DELGADO COLON M.D.

Table of content: STEPHANIE MARIE DELGADO COLON M.D. (NPI 1245786946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245786946 NPI number — STEPHANIE MARIE DELGADO COLON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELGADO COLON
Provider First Name:
STEPHANIE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DELGADO COLON
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1245786946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 HARWOOD CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KISSMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34744-8401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-376-2330
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12609 NARCOOSSEE RD
Provider Second Line Business Practice Location Address:
200B
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-378-6686
Provider Business Practice Location Address Fax Number:
407-378-4633
Provider Enumeration Date:
09/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: ME148199 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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