Mr. Stephen E. Theriault PA-C
Surgical Physician Assistant in Melbourne, FL(View on Map)
Full Name
Mr. Stephen Emile Theriault PA-C
NPI Number
1134262710
NPI Type
Individual Provider
Gender
Male
Enumeration Date
02/14/2007
Specialties
(Taxonomies)Code
363AS0400X
363AM0700X
Primary Taxonomy
Yes
No
Licenses
State
Florida
New Hampshire
License Number
PA9104153
0227
Contact
Information
Purpose
Mailing
Location
Address
1341 MEDICAL PARK DR
1341 MEDICAL PARK DR
City
Melbourne
Melbourne
State
FL
FL
Postal Code
32901-3235
32901-3235
Country
US
US
Telephone Number
(321) 953-1225
(321) 953-1225
Identifiers
Identifier
292994500
Identifier State
FL
Identifier Issuer
Unknown
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 01/28/2010
Provider Address
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