MEDICARE: STEPHANIE NSIAH NP

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	407686	NY
2	163WC0200X	Critical Care Medicine Registered Nurse	756400	NY
3	363LF0000X	Family Nurse Practitioner	350998	NY

General Provider Information

NPI Number	:	1689369878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE NSIAH NP

Provider Business Mailing Address
First Line	:	4825 NORSTAR BLVD APT 309
Second Line	:
City	:	LIVERPOOL
State	:	NY
Zip	:	13088-4295
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8950 E GERMANN RD STE 103
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-5301
Country	:	US
Telephone Number	:	407-305-2920
Fax Number	:	407-550-3718

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

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	02/04/2026

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