Healthcare Provider Details

I. General information

NPI: 1891310512
Provider Name (Legal Business Name): STEPHANIE ESPERANCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 DELAWARE AVE
FREEPORT NY
11520-1315
US

IV. Provider business mailing address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

V. Phone/Fax

Practice location:
  • Phone: 516-500-9208
  • Fax:
Mailing address:
  • Phone: 516-632-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345600-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: