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General NPI Number Information
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NPI Number | 1629259668
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Entity Type | Individual
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Provider Name | STEPHANIE NUCCI II PA
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Gender | Female
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 02/01/2010
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Provider Practice Location Address
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Address Line | 635 BELLE TERRE RD SUITE #204
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1935
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Country | US
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Telephone | 631-474-0008
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Fax | 631-474-0224
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Provider Business Mailing Address
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Address Line | 635 BELLE TERRE RD SUITE #204
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1935
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Country | US
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Telephone | 631-474-0008
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Fax | 631-474-0224
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 009608
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License Number State | NY
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