Provider Demographics
NPI:1255405809
Name:SCIONTI, STEPHEN M (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:SCIONTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 UNIVERSITY PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-9041
Mailing Address - Country:US
Mailing Address - Phone:941-702-5595
Mailing Address - Fax:888-492-0296
Practice Address - Street 1:6600 UNIVERSITY PKWY STE 203
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-9041
Practice Address - Country:US
Practice Address - Phone:941-702-5595
Practice Address - Fax:888-492-0296
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA249866208800000X
SC15312208800000X
FLME119376208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14V0FOtherBCBS FL
SC571087172OtherBLUE CROSS
SC571087172OtherAETNA
SCE71276616Medicare ID - Type UnspecifiedMEDICARE
SC571087172OtherBLUE CROSS
FL14V0FOtherBCBS FL