Provider Demographics
NPI:1861814345
Name:BUNICH, STELLA
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:BUNICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 174TH ST
Mailing Address - Street 2:APT 404
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3300
Mailing Address - Country:US
Mailing Address - Phone:786-200-1046
Mailing Address - Fax:
Practice Address - Street 1:251 174TH ST
Practice Address - Street 2:APT 404
Practice Address - City:SUNNY ISLES
Practice Address - State:FL
Practice Address - Zip Code:33160
Practice Address - Country:US
Practice Address - Phone:786-200-1046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15859225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist