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General NPI Number Information
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NPI Number | 1679894638
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Entity Type | Individual
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Provider Name | CHRYSTYNA STASYSHYN RPA-C
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Gender | Female
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 149 MADISON AVE SUITE #702
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City | NEW YORK
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State | NY
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Zip | 10016
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Country | US
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Telephone | 917-524-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 6169 69TH PL
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-1126
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Country | US
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Telephone | 718-440-2285
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 013930
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License Number State | NY
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