Provider Demographics
NPI:1750917464
Name:CORIOLAN, STEPHANOR
Entity type:Individual
Prefix:
First Name:STEPHANOR
Middle Name:
Last Name:CORIOLAN
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 1:729 SHERWOOD TERRACE DR APT 105
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-7404
Mailing Address - Country:US
Mailing Address - Phone:561-618-6881
Mailing Address - Fax:
Practice Address - Street 1:729 SHERWOOD TERRACE DR APT 105
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-7404
Practice Address - Country:US
Practice Address - Phone:561-618-6881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-14
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant