Individual
MR. STEPHEN EMILE THERIAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1341 MEDICAL PARK DR, SUITE 201, MELBOURNE, FL 32901-3235
(321) 953-1225
(321) 768-0033
Mailing address
1341 MEDICAL PARK DR, SUITE 201, MELBOURNE, FL 32901-3235
(321) 953-1225
(321) 768-0033
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0227
NH
363AS0400X
Surgical Physician Assistant
Primary
PA9104153
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292994500
—
FL
Enumeration date
02/14/2007
Last updated
01/28/2010
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