Provider Demographics
NPI:1083971220
Name:STEPHANIE LEIGH SILBERBERG
Entity Type:Organization
Organization Name:STEPHANIE LEIGH SILBERBERG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SILBERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-939-5275
Mailing Address - Street 1:8418 E BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-6306
Mailing Address - Country:US
Mailing Address - Phone:850-939-5275
Mailing Address - Fax:850-939-4152
Practice Address - Street 1:8418 E BAY BLVD
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-6306
Practice Address - Country:US
Practice Address - Phone:850-939-5275
Practice Address - Fax:850-939-4152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78917207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257382200Medicaid