Mallone-Stead, Susan Marie

Mallone-Stead, Susan Marie is an sole proprietor health care provider with primary practice located at 4751 S Cleveland Ave , Fort Myers FL 33907-1317. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics. Physician Assistants & Advanced Practice Nursing Providers / Pediatrics is her primary health care specialty. Mallone-Stead, Susan Marie can be contacted via phone (239) 343-9888.

Contact Information

Primary practice address
4751 S Cleveland Ave Fort Myers FL 33907-1317
Phone: (239) 343-9888
Fax: (239) 343-9868
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X APRN9395706 Florida
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X APRN9395706 Florida

Profile Details

NPI number 1487658316
LBN Legal business name Mallone-Stead, Susan Marie
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 9th, 2005
Last updated Jan 31st, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487658316 NPPES
Florida MEDICAID 013881500
Florida MEDICAID 02136749

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