Healthcare Provider Details

I. General information

NPI: 1801477898
Provider Name (Legal Business Name): TRINA SUE STIFF CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 BELL BLVD
BAYSIDE NY
11361-2061
US

IV. Provider business mailing address

21353 35TH AVE APT 1
BAYSIDE NY
11361-1766
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-2606
  • Fax: 718-224-8083
Mailing address:
  • Phone: 718-306-4559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30138009
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: