Healthcare Provider Details

I. General information

NPI: 1790134500
Provider Name (Legal Business Name): STEPHANIE NEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36-11 21ST STREET
LONG ISLAND CITY NY
11106-4505
US

IV. Provider business mailing address

515 MADISON AVE RM 2310
NEW YORK NY
10022-5430
US

V. Phone/Fax

Practice location:
  • Phone: 718-482-7772
  • Fax: 718-482-9648
Mailing address:
  • Phone: 917-513-8537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number686668
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF402088
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: