Provider Demographics
NPI:1972310878
Name:MCNALLY, STEPHEN E (CRPS)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:E
Last Name:MCNALLY
Suffix:
Gender:M
Credentials:CRPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 S WAYMAN ST APT 101
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5320
Mailing Address - Country:US
Mailing Address - Phone:321-422-8412
Mailing Address - Fax:
Practice Address - Street 1:4508 THISTLEDOWN DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1244
Practice Address - Country:US
Practice Address - Phone:321-422-8412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRPS.0100252.A175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist