MEDICARE: STEPHANIE SY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	047358	NY

General Provider Information

NPI Number	:	1174813117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SY

Provider Business Mailing Address
First Line	:	1181 LIBERTY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-3308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1181 LIBERTY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-3308
Country	:	US
Telephone Number	:	718-277-1580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	04/11/2011

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Directions to “ STEPHANIE SY ” Practice Location

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