Healthcare Provider Details

I. General information

NPI: 1679046411
Provider Name (Legal Business Name): STELLA A STELIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 ERIE BLVD W
SYRACUSE NY
13204-2445
US

IV. Provider business mailing address

518 JAMES ST
SYRACUSE NY
13203-2238
US

V. Phone/Fax

Practice location:
  • Phone: 315-472-7363
  • Fax: 315-472-0084
Mailing address:
  • Phone: 315-474-5506
  • Fax: 315-474-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406905
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number754978
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: