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General NPI Number Information
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NPI Number | 1396235438
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Entity Type | Individual
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Provider Name | STEPHANIE DEMASO MD
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Gender | Female
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 5100 W TAFT RD
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City | LIVERPOOL
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State | NY
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Zip | 13088-3807
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Country | US
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Telephone | 315-452-2828
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Fax |
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Provider Business Mailing Address
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Address Line | 217 PEAKWOOD LN APT 22
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City | BALDWINSVILLE
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State | NY
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Zip | 13027-3078
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Country | US
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Telephone | 517-648-5928
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Fax | 315-448-6313
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 313608
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License Number State | NY
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