Healthcare Provider Details

I. General information

NPI: 1689369878
Provider Name (Legal Business Name): STEPHANIE NSIAH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 10/18/2025
Certification Date: 10/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 MATTHEWS AVE
BRONX NY
10462-2614
US

IV. Provider business mailing address

4825 NORSTAR BLVD APT 309
LIVERPOOL NY
13088-4295
US

V. Phone/Fax

Practice location:
  • Phone: 718-794-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407686
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number756400
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number350998
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: