Provider Demographics
NPI:1104356526
Name:STORER BEAUCHAMP, MARIA JUDITH (CST)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:JUDITH
Last Name:STORER BEAUCHAMP
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 JAMESTOWN BLVD APT 2271
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-4691
Mailing Address - Country:US
Mailing Address - Phone:954-851-5417
Mailing Address - Fax:
Practice Address - Street 1:714 JAMESTOWN BLVD APT 2271
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPG
Practice Address - State:FL
Practice Address - Zip Code:32714-4691
Practice Address - Country:US
Practice Address - Phone:954-851-5417
Practice Address - Fax:954-851-5417
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL143194246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist