Provider Demographics
NPI:1245786946
Name:DELGADO COLON, STEPHANIE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:DELGADO COLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:DELGADO COLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:105 HARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:KISSMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-8401
Mailing Address - Country:US
Mailing Address - Phone:787-376-2330
Mailing Address - Fax:
Practice Address - Street 1:12609 NARCOOSSEE RD
Practice Address - Street 2:200B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832
Practice Address - Country:US
Practice Address - Phone:407-378-6686
Practice Address - Fax:407-378-4633
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME148199208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program