Healthcare Provider Details

I. General information

NPI: 1457423014
Provider Name (Legal Business Name): STEPHEN WESLEY MUNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LINDEN OAKS SUITE 200
ROCHESTER NY
14625-2840
US

IV. Provider business mailing address

100 CHEESE FACTORY RD
HONEOYE FALLS NY
14472-9303
US

V. Phone/Fax

Practice location:
  • Phone: 585-586-1600
  • Fax: 585-586-7951
Mailing address:
  • Phone: 585-586-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberNY125762
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: