Provider Demographics
NPI:1518160779
Name:MCNALLY, STEPHEN E SR (CST CFA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:E
Last Name:MCNALLY
Suffix:SR
Gender:M
Credentials:CST CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 SE 5TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5172
Mailing Address - Country:US
Mailing Address - Phone:561-900-2498
Mailing Address - Fax:888-972-4762
Practice Address - Street 1:4215 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-2206
Practice Address - Country:US
Practice Address - Phone:407-539-2000
Practice Address - Fax:407-398-0050
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF01487OtherNBSTSA CERT CST/CFA