Healthcare Provider Details

I. General information

NPI: 1386005312
Provider Name (Legal Business Name): STEPHANIE M GARLAND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 FLY ROAD SUITE 305
EAST SYRACUSE NY
13057
US

IV. Provider business mailing address

251 SALINA MEADOWS PARKWAY SUITE 100
SYRACUSE NY
13212
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-3938
  • Fax: 315-464-5359
Mailing address:
  • Phone: 315-464-2096
  • Fax: 315-464-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6844
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number339744
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number339744
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: