Healthcare Provider Details

I. General information

NPI: 1124930904
Provider Name (Legal Business Name): STEPHANIE DABIEDEEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12256 134TH ST
SOUTH OZONE PARK NY
11420-3015
US

IV. Provider business mailing address

12256 134TH ST
SOUTH OZONE PARK NY
11420-3015
US

V. Phone/Fax

Practice location:
  • Phone: 929-582-0270
  • Fax:
Mailing address:
  • Phone: 929-582-0270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number357631
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: