Theriault, Stephen Emile

Theriault, Stephen Emile is an individual health care provider with primary practice located at 1341 Medical Park Dr Suite 201, Melbourne FL 32901-3235. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is his primary health care specialty. Theriault, Stephen Emile can be contacted via phone (321) 953-1225.

Contact Information

Primary practice address
1341 Medical Park Dr Suite 201 Melbourne FL 32901-3235
Phone: (321) 953-1225
Fax: (321) 768-0033
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 0227 New Hampshire
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA9104153 Florida

Profile Details

NPI number 1134262710
LBN Legal business name Theriault, Stephen Emile
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2007
Last updated Jan 28th, 2010 - about 16 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 1134262710 NPPES
Florida MEDICAID 292994500

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