Individual
STEPHANIE ROSHONN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
344 S BEACH ST, DAYTONA BEACH, FL 32114-5035
(352) 323-0612
(386) 258-2283
Mailing address
344 S BEACH ST, DAYTONA BEACH, FL 32114-5035
(352) 323-0612
(386) 258-2283
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7660511000
—
FL
Enumeration date
02/22/2007
Last updated
07/08/2007
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