Provider Demographics
NPI:1942408695
Name:LIMA, STEFANIA VAREJAO DE MELO E (MD)
Entity Type:Individual
Prefix:
First Name:STEFANIA
Middle Name:VAREJAO DE MELO E
Last Name:LIMA
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 1:1651 N SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3575
Mailing Address - Country:US
Mailing Address - Phone:407-249-1234
Mailing Address - Fax:407-249-1755
Practice Address - Street 1:1651 N SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3575
Practice Address - Country:US
Practice Address - Phone:407-249-1234
Practice Address - Fax:407-249-1755
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108807208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003525800Medicaid
14CQ3OtherBLUE CROSS BLUE SHIELD