Basic Information
| Provider Information | |||||||||
| NPI: | 1225236599 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STUMBO | ||||||||
| FirstName: | NATALIYA | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1447 MEDICAL PARK BLVD | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334143164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617902600 | ||||||||
| FaxNumber: | 5617901535 | ||||||||
| Practice Location | |||||||||
| Address1: | 1447 MEDICAL PARK BLVD | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334143164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617902600 | ||||||||
| FaxNumber: | 5617901535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2007 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 1732 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 0510639 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 003118500 | 05 | FL | MEDICAID |