Provider Demographics
NPI:1255477105
Name:STELNICKI, THOMAS D (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:STELNICKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7509 ST RT 52
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667
Mailing Address - Country:US
Mailing Address - Phone:727-869-9559
Mailing Address - Fax:727-869-9331
Practice Address - Street 1:7509 ST RT 52
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-869-9559
Practice Address - Fax:727-869-9331
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP807213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041345301Medicaid
87317Medicare PIN
FLT95141Medicare UPIN