Healthcare Provider Details

I. General information

NPI: 1740739515
Provider Name (Legal Business Name): STEPHANIE ZITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 CAPE RD
MILFORD MA
01757-3292
US

IV. Provider business mailing address

42 CAPE RD
MILFORD MA
01757-3292
US

V. Phone/Fax

Practice location:
  • Phone: 508-852-1805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2311028
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: