Provider Demographics
NPI:1194719823
Name:KNYCH, STEPHEN ALBERT
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALBERT
Last Name:KNYCH
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 1:822 SPRING PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4831
Mailing Address - Country:US
Mailing Address - Phone:407-566-8808
Mailing Address - Fax:407-566-8554
Practice Address - Street 1:822 SPRING PARK LOOP
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4831
Practice Address - Country:US
Practice Address - Phone:407-566-8808
Practice Address - Fax:407-566-8554
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90281174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist