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NPI Code Detail

MEDICARE: DESIREE STUCKEY

MEDICARE: DESIREE STUCKEY
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
1174400000XSpecialistNY

General Provider Information

NPI Number : 1609734300
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESIREE STUCKEY
Provider Business Mailing Address
First Line : 33 HOME PL
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10302-2425
Country : US
Telephone Number : 917-842-2038
Fax Number :
Provider Business Practice Location Address
First Line : 1250 HYLAN BLVD STE 9B1
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-1945
Country : US
Telephone Number : 917-397-8947
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2026
Last Update Date : 01/12/2026

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Directions to “ DESIREE STUCKEY ” Practice Location

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