Provider Demographics
NPI:1437598596
Name:VAN HEERDEN, STEPHANIE DANIELLE (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:DANIELLE
Last Name:VAN HEERDEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:DANIELLE
Other - Last Name:GILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:19067 ELSTON WAY
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6512
Mailing Address - Country:US
Mailing Address - Phone:812-525-7737
Mailing Address - Fax:
Practice Address - Street 1:9915 TAMIAMI TRL N STE 1
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1927
Practice Address - Country:US
Practice Address - Phone:239-566-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001250B213E00000X
FLPO4270213E00000X, 213ES0103X
IN07001250A213ES0131X
PASC006699213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery