Provider Demographics
NPI:1962581157
Name:TALTON-WILLIAMSON, STEPHANIE YVONNE (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:YVONNE
Last Name:TALTON-WILLIAMSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:YVONNE
Other - Last Name:TALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2352 CREEL LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-4622
Mailing Address - Country:US
Mailing Address - Phone:813-866-4200
Mailing Address - Fax:813-866-4224
Practice Address - Street 1:2352 CREEL LN
Practice Address - Street 2:SUITE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-4622
Practice Address - Country:US
Practice Address - Phone:813-866-4200
Practice Address - Fax:813-866-4224
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78701207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258488300Medicaid
FL49156AMedicare ID - Type Unspecified
FL258488300Medicaid