1083623896 NPI number — STEPHANIE C SPINELLI AND ASSOCIATES

Table of content: (NPI 1083623896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083623896 NPI number — STEPHANIE C SPINELLI AND ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHANIE C SPINELLI AND ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DISTINCTIVE PEDIATRIC THERAPY
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083623896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 LAKE BEAUTY DR STE 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32806-2040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-896-1152
Provider Business Mailing Address Fax Number:
407-872-3014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
427 N MAGNOLIA AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32801-1524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-896-1152
Provider Business Practice Location Address Fax Number:
407-872-3014
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPINELLI
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
CASERTA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-896-1152

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2265418 . This is a "AETNA HM0" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5410590 . This is a "AETNA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 882631500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Z5844 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 882631500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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