Provider Demographics
NPI:1013724046
Name:STURIALE, DOMENICO ANTONIO
Entity type:Individual
Prefix:
First Name:DOMENICO
Middle Name:ANTONIO
Last Name:STURIALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 SW 64TH AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4081
Mailing Address - Country:US
Mailing Address - Phone:407-822-9220
Mailing Address - Fax:
Practice Address - Street 1:2601 SW 64TH AVE UNIT 6
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-4081
Practice Address - Country:US
Practice Address - Phone:407-822-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician