Provider Demographics
NPI:1902242803
Name:FIORE, STEPHANY ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:ELLEN
Last Name:FIORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 BROADWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-1540
Mailing Address - Country:US
Mailing Address - Phone:916-874-9382
Mailing Address - Fax:
Practice Address - Street 1:4800 BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1540
Practice Address - Country:US
Practice Address - Phone:916-874-9382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68925207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology