Provider Demographics
NPI:1144506775
Name:DENNY, STEPHEN RANDALL (PA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RANDALL
Last Name:DENNY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:725 RODEL CV
Mailing Address - Street 2:STE 100
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4859
Mailing Address - Country:US
Mailing Address - Phone:407-977-4130
Mailing Address - Fax:
Practice Address - Street 1:725 RODEL CV STE 100
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4859
Practice Address - Country:US
Practice Address - Phone:407-977-4130
Practice Address - Fax:407-977-4139
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106142363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical