Provider Demographics
NPI:1982678306
Name:CHIARELLO, STEPHEN E (MDPA)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:CHIARELLO
Suffix:
Gender:M
Credentials:MDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 TAMIAMI TRL
Mailing Address - Street 2:SUITE 20
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8053
Mailing Address - Country:US
Mailing Address - Phone:941-625-2879
Mailing Address - Fax:941-627-4389
Practice Address - Street 1:3280 TAMIAMI TRL
Practice Address - Street 2:SUITE 20
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8053
Practice Address - Country:US
Practice Address - Phone:941-625-2879
Practice Address - Fax:941-627-4389
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2023-06-06
Deactivation Date:2022-08-01
Deactivation Code:
Reactivation Date:2023-06-06
Provider Licenses
StateLicense IDTaxonomies
FLME0034901174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58795Medicare UPIN
FL79458Medicare ID - Type Unspecified