Provider Demographics
NPI:1215253471
Name:PATRONE, STEFANIE VINCENZINA (MD)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:VINCENZINA
Last Name:PATRONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:VINCENZINA
Other - Last Name:STACHURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:904-697-4203
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:7455 PINEMIRE DRIVE
Practice Address - Street 2:NEMOURS CHILDRENS PRIMARY CARE, OVIEDO
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6094
Practice Address - Country:US
Practice Address - Phone:407-542-1733
Practice Address - Fax:407-542-1740
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49441208000000X
FLME123257208D00000X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN49441OtherTN STATE LICENSE
FLME123257OtherFL MEDICAL LICENSE