MEDICARE: MS. STEPHANIE ANN STEPHENS MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency
2	252Y00000X	Early Intervention Provider Agency	1278088	NY

General Provider Information

NPI Number	:	1083013304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE ANN STEPHENS MS

Provider Business Mailing Address
First Line	:	25704 149TH AVE
Second Line	:
City	:	ROSEDALE
State	:	NY
Zip	:	11422-3021
Country	:	US
Telephone Number	:	718-791-3753
Fax Number	:

Provider Business Practice Location Address
First Line	:	19108 120TH RD
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-3619
Country	:	US
Telephone Number	:	718-791-3753
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2014
Last Update Date	:	05/13/2025

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