Provider Demographics
NPI:1215545199
Name:BOOKER, STEPHANIE T
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:T
Last Name:BOOKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 SCHOLAR CT
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-2047
Mailing Address - Country:US
Mailing Address - Phone:239-308-6614
Mailing Address - Fax:
Practice Address - Street 1:1535 SCHOLAR CT
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-2047
Practice Address - Country:US
Practice Address - Phone:239-308-6614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities