person
Mr. Stephen Emile Theriault, PA-C
Surgical Physician Assistant in Melbourne, Florida
NPI 1134262710

Stephen Emile Theriault is a Surgical Physician Assistant based in Melbourne, FL and is specialized in Surgical. Stephen Emile Theriault practices in Melbourne, FL and has the professional credentials of PA-C. The NPI Number for Stephen Emile Theriault is 1134262710 and holds a License No. 0227 (Florida).

The current practice location address for Stephen Emile Theriault is 1341 Medical Park Dr, Melbourne, FL and can be reached out via phone at 321-953-1225 and via fax at 321-768-0033.

Location: 1341 Medical Park Dr, Melbourne, FL, 32901-3235
person
Provider Profile Details
NPI Number
1134262710
Provider Name
Stephen Emile Theriault
Credential
PA-C
Provider Entity Type
Individual
Gender
Male
Address
1341 Medical Park Dr, Melbourne, FL, 32901-3235
Phone Number
321-953-1225
Fax Number
321-768-0033
Provider Enumeration Date
02/14/2007
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
292994500 05 FL
institution
Provider Business Practice Location Address Details
Address
1341 Medical Park Dr
City
State
Zip
32901-3235
Phone Number
321-953-1225
Fax Number
321-768-0033
person
Provider Business Mailing Address Details
Address
1341 Medical Park Dr
City
State
Zip
32901-3235
Phone Number
321-953-1225
Fax Number
321-768-0033
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
PA9104153 (Florida)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Surgical
Taxonomy
License No.
0227 (New Hampshire)
Definition
Definition to come...
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