Provider Demographics
NPI:1518138064
Name:CONDILL, STEPHAN ANTHONY (AUD)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:ANTHONY
Last Name:CONDILL
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:DR
Other - First Name:STEPHAN
Other - Middle Name:ANTHONY
Other - Last Name:CONDILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:1601 PARK CENTER DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5700
Mailing Address - Country:US
Mailing Address - Phone:407-413-5680
Mailing Address - Fax:407-413-5682
Practice Address - Street 1:1601 PARK CENTER DR
Practice Address - Street 2:SUITE 8
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5700
Practice Address - Country:US
Practice Address - Phone:407-413-5680
Practice Address - Fax:407-413-5682
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1370231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist