Provider Demographics
NPI:1821396847
Name:VALES, STEPHANIE VICTORIA (MA35807)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:VICTORIA
Last Name:VALES
Suffix:
Gender:F
Credentials:MA35807
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3875
Mailing Address - Country:US
Mailing Address - Phone:407-393-0432
Mailing Address - Fax:
Practice Address - Street 1:206 CHARLES STREET
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5402
Practice Address - Country:US
Practice Address - Phone:407-393-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA35807174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist