Provider Demographics
NPI:1588440895
Name:AVILES, STEPHANO DANIEL
Entity type:Individual
Prefix:MR
First Name:STEPHANO
Middle Name:DANIEL
Last Name:AVILES
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 1:4940 NORTHDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1075
Mailing Address - Country:US
Mailing Address - Phone:813-485-8444
Mailing Address - Fax:
Practice Address - Street 1:4940 NORTHDALE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1075
Practice Address - Country:US
Practice Address - Phone:813-485-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-23-294236OtherSHAPING EXPECTATIONS THERAPY