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General NPI Number Information
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NPI Number | 1740769561
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Entity Type | Individual
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Provider Name | STEPHANIE CLEMONS
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Gender | Female
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 183 FLORIDA ST # 2
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City | BUFFALO
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State | NY
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Zip | 14208-1213
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Country | US
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Telephone | 716-886-6843
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Fax |
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Provider Business Mailing Address
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Address Line | 183 FLORIDA ST # 2
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City | BUFFALO
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State | NY
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Zip | 14208-1213
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Country | US
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Telephone | 716-886-6843
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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 | 344600000X
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Taxonomy Name | Taxi
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License Number | 402488020
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License Number State | NY
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