Provider Demographics
NPI:1588600308
Name:CAYELLI, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:CAYELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:IVA
Mailing Address - State:SC
Mailing Address - Zip Code:29655-0267
Mailing Address - Country:US
Mailing Address - Phone:864-348-6122
Mailing Address - Fax:864-348-7892
Practice Address - Street 1:331 ANTREVILLE HWY
Practice Address - Street 2:
Practice Address - City:IVA
Practice Address - State:SC
Practice Address - Zip Code:29655-9548
Practice Address - Country:US
Practice Address - Phone:864-348-6122
Practice Address - Fax:864-348-7892
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT42344Medicaid
00803228AOtherRAILROAD MEDICARE
GA080182548OtherGEORGIA MEDICAID
G46903Medicare UPIN
SCSC60886315Medicare PIN
SCT42344Medicaid
SCSC60887842Medicare PIN