Provider Demographics
NPI:1528955606
Name:IZZO, STEFANIE (LAC, DIPL OM)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:IZZO
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 SW 32ND AVE APT 609
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3182
Mailing Address - Country:US
Mailing Address - Phone:617-749-6732
Mailing Address - Fax:
Practice Address - Street 1:2200 BISCAYNE BLVD FL 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-5283
Practice Address - Country:US
Practice Address - Phone:617-749-6732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4650171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist