Provider Demographics
NPI:1700866985
Name:STELNICKI, ERIC JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JASON
Last Name:STELNICKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 SE 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3908
Mailing Address - Country:US
Mailing Address - Phone:954-983-1899
Mailing Address - Fax:954-318-3215
Practice Address - Street 1:100 SE 15TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3908
Practice Address - Country:US
Practice Address - Phone:954-983-1899
Practice Address - Fax:954-318-3215
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77501208200000X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255848300Medicaid
FLF91672Medicare UPIN