Provider Demographics
NPI:1386941656
Name:STEFA, NICHOLAS M
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:M
Last Name:STEFA
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 1:10002 FRIERSON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34669-3401
Mailing Address - Country:US
Mailing Address - Phone:727-857-3501
Mailing Address - Fax:
Practice Address - Street 1:10002 FRIERSON LAKE DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34669-3401
Practice Address - Country:US
Practice Address - Phone:727-857-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAST23237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist