Provider Demographics
NPI:1659754562
Name:AYRES, STEPHNEY D (DOM)
Entity Type:Individual
Prefix:
First Name:STEPHNEY
Middle Name:D
Last Name:AYRES
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18801 LEETANA RD
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-4741
Mailing Address - Country:US
Mailing Address - Phone:239-898-0277
Mailing Address - Fax:
Practice Address - Street 1:18801 LEETANA RD
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-4741
Practice Address - Country:US
Practice Address - Phone:239-898-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL9199078163W00000X
FLAP3641171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse