Provider Demographics
NPI:1194015040
Name:BUTTACCIO, STEPHANIE (AP, DOM)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:BUTTACCIO
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 N ATLANTIC AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-5046
Mailing Address - Country:US
Mailing Address - Phone:585-905-1553
Mailing Address - Fax:
Practice Address - Street 1:950 N COURTENAY PKWY STE 1
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4501
Practice Address - Country:US
Practice Address - Phone:321-453-2844
Practice Address - Fax:321-452-6452
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2578171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist