MEDICARE: STEPHANIE STAIDLE

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	171400000X	Health & Wellness Coach
2	221700000X	Art Therapist	001364	NY

General Provider Information

NPI Number	:	1427947340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE STAIDLE

Provider Business Mailing Address
First Line	:	10154 SIERRA VISTA AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-4335
Country	:	US
Telephone Number	:	203-610-2671
Fax Number	:

Provider Business Practice Location Address
First Line	:	7235 112TH ST APT 11F
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5443
Country	:	US
Telephone Number	:	203-610-2671
Fax Number	:

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

Provider Enumeration Date	:	07/03/2025
Last Update Date	:	07/03/2025

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Directions to “ STEPHANIE STAIDLE ” Practice Location

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