Provider Demographics
NPI:1629560404
Name:COREY, STEFFANI
Entity Type:Individual
Prefix:
First Name:STEFFANI
Middle Name:
Last Name:COREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13135 BURNS DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-4079
Mailing Address - Country:US
Mailing Address - Phone:727-203-0660
Mailing Address - Fax:
Practice Address - Street 1:13135 BURNS DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-4079
Practice Address - Country:US
Practice Address - Phone:727-203-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty