Provider Demographics
NPI:1982381851
Name:PORTO, STEPHANY NICOLE
Entity type:Individual
Prefix:
First Name:STEPHANY
Middle Name:NICOLE
Last Name:PORTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3432 NE 3RD DR
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7187
Mailing Address - Country:US
Mailing Address - Phone:786-490-3038
Mailing Address - Fax:
Practice Address - Street 1:3432 NE 3RD DR
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7187
Practice Address - Country:US
Practice Address - Phone:786-490-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-280160106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician