Provider Demographics
NPI:1447659537
Name:CUMMINGS, STEPHANIE R
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:CUMMINGS
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 1:1805 N ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-3013
Mailing Address - Country:US
Mailing Address - Phone:352-735-1904
Mailing Address - Fax:352-735-1904
Practice Address - Street 1:1805 N ORANGE ST
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-3013
Practice Address - Country:US
Practice Address - Phone:352-735-1904
Practice Address - Fax:352-735-1904
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL005442800251C00000X
FL006666600251E00000X
FL006631900251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006666600Medicaid
FL006631900Medicaid
FL005442800Medicaid