Healthcare Provider Details

I. General information

NPI: 1629995030
Provider Name (Legal Business Name): STASHA LEE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 31ST ST FL 2
ASTORIA NY
11102-1745
US

IV. Provider business mailing address

660 WHITE PLAINS RD FL 4
TARRYTOWN NY
10591-5187
US

V. Phone/Fax

Practice location:
  • Phone: 718-971-2490
  • Fax:
Mailing address:
  • Phone: 914-333-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number003392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: