Healthcare Provider Details

I. General information

NPI: 1417684143
Provider Name (Legal Business Name): STEPHANIE INFANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2539 MIDDLE COUNTRY RD STE 4
CENTEREACH NY
11720-3503
US

IV. Provider business mailing address

188 AUSTIN ST
LINDENHURST NY
11757-5303
US

V. Phone/Fax

Practice location:
  • Phone: 631-737-6434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number677998
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: