Healthcare Provider Details

I. General information

NPI: 1275224537
Provider Name (Legal Business Name): STEPHANIE MARIE PICHARDO CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 MYRTLE AVE
BROOKLYN NY
11237-4512
US

IV. Provider business mailing address

10415 35TH AVE APT 3F
CORONA NY
11368-1972
US

V. Phone/Fax

Practice location:
  • Phone: 718-907-4301
  • Fax:
Mailing address:
  • Phone: 347-701-0359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number383508
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: