Individual
STEPHANIE PRADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD.
Contact information
Practice address
8745 N WICKHAM RD, MELBOURNE, FL 32940-5997
(321) 434-9358
(321) 434-9170
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-9358
(321) 951-7408
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME113082
FL
208M00000X
Hospitalist Physician
Primary
ME113082
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005946900
—
FL
01
—
GI464X
MEDICARE
FL
Enumeration date
11/20/2009
Last updated
10/26/2023
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