Provider Demographics
NPI:1285408963
Name:PEACOCK, STEPHANIE ALYCE (HAS)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ALYCE
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2568 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-5980
Mailing Address - Country:US
Mailing Address - Phone:386-410-3207
Mailing Address - Fax:
Practice Address - Street 1:2568 S RIDGEWOOD AVE STE 1
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32141-7535
Practice Address - Country:US
Practice Address - Phone:386-410-3207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter