Provider Demographics
NPI:1295017291
Name:SWENEY, STEPHEN MATHER
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:MATHER
Last Name:SWENEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10935 BRISTOL BAY DR
Mailing Address - Street 2:#207
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-7761
Mailing Address - Country:US
Mailing Address - Phone:941-896-4089
Mailing Address - Fax:
Practice Address - Street 1:10935 BRISTOL BAY DR
Practice Address - Street 2:#207
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7761
Practice Address - Country:US
Practice Address - Phone:941-896-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS500793542070172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver