Provider Demographics
NPI:1821034828
Name:CARADONNA, STEPHANIE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANN
Last Name:CARADONNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 CRANE PRAIRIE WAY
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-7812
Mailing Address - Country:US
Mailing Address - Phone:941-966-2310
Mailing Address - Fax:
Practice Address - Street 1:2179 S TAMIAMI TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9239
Practice Address - Country:US
Practice Address - Phone:941-966-0222
Practice Address - Fax:941-966-5100
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87302174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7219515OtherAETNA
FL11076163OtherCIGNA
FL79325OtherBCBSFL
FLDA7568OtherRAILROAD MEDICARE
FL79325OtherBCBSFL
FLH96056Medicare UPIN