MEDICARE: STACY SCHOENBACH, NURSE PRACTITIONER PSYCHIATRIC SERVICES PC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1093407132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STACY SCHOENBACH, NURSE PRACTITIONER PSYCHIATRIC SERVICES PC

Provider Business Mailing Address
First Line	:	200 BROADHOLLOW RD STE 207
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-4806
Country	:	US
Telephone Number	:	631-707-2394
Fax Number	:	631-824-9118

Provider Business Practice Location Address
First Line	:	200 BROADHOLLOW RD STE 207
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-4806
Country	:	US
Telephone Number	:	631-707-2394
Fax Number	:	631-824-9118

Authorized Official
Title or Position	:	PSYCHIATRIC NURSE PRACTITIONER
Name	:	STACY SCHOENBACH
Credential	:	DNP
Telephone Number	:	631-707-2394

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	06/30/2023

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