Healthcare Provider Details

I. General information

NPI: 1205790508
Provider Name (Legal Business Name): MRS. STACEY L STELIANOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 HAMILTON RD
FAIRPORT NY
14450-9711
US

IV. Provider business mailing address

181 HAMILTON RD
FAIRPORT NY
14450-9711
US

V. Phone/Fax

Practice location:
  • Phone: 585-421-2142
  • Fax: 585-421-8721
Mailing address:
  • Phone: 585-421-2142
  • Fax: 585-421-8721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2956564
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: