Provider Demographics
NPI:1710024526
Name:MCKENZY, STEVEN (PHD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:MCKENZY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 SOUTH SEMINOLE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:FL
Mailing Address - Zip Code:33841-3446
Mailing Address - Country:US
Mailing Address - Phone:863-448-7476
Mailing Address - Fax:863-285-9286
Practice Address - Street 1:414 S SEMINOLE AVE
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:FL
Practice Address - Zip Code:33841-3446
Practice Address - Country:US
Practice Address - Phone:863-519-9444
Practice Address - Fax:863-285-9286
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 37847174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6915027 96Medicaid
FL6915027 03Medicaid
FL6915027 98Medicaid