Provider Demographics
NPI:1326476797
Name:DUKES, STEPHANIE M (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:M
Last Name:DUKES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:M
Other - Last Name:FRYBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:5355 SOUNDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-7238
Mailing Address - Country:US
Mailing Address - Phone:260-402-8057
Mailing Address - Fax:
Practice Address - Street 1:5355 SOUNDVIEW AVE
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-7238
Practice Address - Country:US
Practice Address - Phone:260-402-8057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist