MEDICARE: STACEY COMO LPN

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	164W00000X	Licensed Practical Nurse	315206	NY

General Provider Information

NPI Number	:	1528932381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY COMO LPN

Provider Business Mailing Address
First Line	:	124 BAYBERRY DR
Second Line	:
City	:	DINGMANS FERRY
State	:	PA
Zip	:	18328-3500
Country	:	US
Telephone Number	:	718-928-3355
Fax Number	:

Provider Business Practice Location Address
First Line	:	6650 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7057
Country	:	US
Telephone Number	:	718-928-3355
Fax Number	:

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

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	10/03/2025

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Directions to “ STACEY COMO LPN” Practice Location

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