Healthcare Provider Details

I. General information

NPI: 1235057530
Provider Name (Legal Business Name): MARY STEFANOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 WOOD CREEK DR
PITTSFORD NY
14534-4411
US

IV. Provider business mailing address

32 WOOD CREEK DR
PITTSFORD NY
14534-4411
US

V. Phone/Fax

Practice location:
  • Phone: 585-694-6617
  • Fax:
Mailing address:
  • Phone: 585-694-6617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF359826
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: