Provider Demographics
NPI:1902348691
Name:MUNDEE, STEPHEN LLOYD
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LLOYD
Last Name:MUNDEE
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 1:727 CIELO AZUL APT B7
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-8816
Mailing Address - Country:US
Mailing Address - Phone:801-916-4502
Mailing Address - Fax:
Practice Address - Street 1:727 CIELO AZUL APT B7
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-8816
Practice Address - Country:US
Practice Address - Phone:801-916-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000018898OtherBOARD OF CERTIFICATION