MEDICARE: MRS. KYRSTEN M STEPHANY AUD

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	231H00000X	Audiologist	002722-1	NY

General Provider Information

NPI Number	:	1700394350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KYRSTEN M STEPHANY AUD

Provider Business Mailing Address
First Line	:	103 CANAL LANDING BLVD
Second Line	:	SUITE 3
City	:	ROCHESTER
State	:	NY
Zip	:	14626-5108
Country	:	US
Telephone Number	:	585-723-3440
Fax Number	:	585-735-4632

Provider Business Practice Location Address
First Line	:	103 CANAL LANDING BLVD
Second Line	:	SUITE 3
City	:	ROCHESTER
State	:	NY
Zip	:	14626-5108
Country	:	US
Telephone Number	:	585-723-3440
Fax Number	:	585-735-4632

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

Provider Enumeration Date	:	01/17/2018
Last Update Date	:	10/17/2019

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