Provider Demographics
NPI:1295412195
Name:ZANIEWSKI MODESTO, STEPHANIE MARIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:ZANIEWSKI MODESTO
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 1:8183 CASSIA DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-5025
Mailing Address - Country:US
Mailing Address - Phone:561-303-7111
Mailing Address - Fax:
Practice Address - Street 1:11423 SEA GRASS CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-4922
Practice Address - Country:US
Practice Address - Phone:561-303-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other