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General NPI Number Information
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NPI Number | 1518849868
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Entity Type | Organization
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Legal Business Name | STELLA'S WAY, LLC
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 1158 45TH ST
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City | BROOKLYN
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State | NY
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Zip | 11219-2059
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Country | US
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Telephone | 718-480-5566
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Fax |
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Provider Business Mailing Address
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Address Line | 1479 E 98TH ST FL 2
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City | BROOKLYN
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State | NY
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Zip | 11236-5321
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Country | US
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Telephone | 347-470-4492
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Fax | 347-492-3289
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETULA SHERYL-ANN SQUIRES
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Credential | MSED
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Telephone | 347-470-4492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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