MEDICARE: MS. MARY ELLEN STAVITZ PNP

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	363LP0200X	Pediatric Nurse Practitioner	F380031	NY

General Provider Information

NPI Number	:	1740481696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ELLEN STAVITZ PNP

Provider Business Mailing Address
First Line	:	50 DAYTON LANE, SUITE 202
Second Line	:	THE WESTCHSTER MEDICAL PRACTICE PC
City	:	PEEKSKILL
State	:	NY
Zip	:	10566
Country	:	US
Telephone Number	:	914-739-0087
Fax Number	:	914-737-1714

Provider Business Practice Location Address
First Line	:	35 S RIVERSIDE AVE
Second Line	:	THE WESTCHESTER M,EDICAL PRACTICE PC
City	:	CROTON ON HUDSON
State	:	NY
Zip	:	10520-2653
Country	:	US
Telephone Number	:	914-271-2424
Fax Number	:	914-271-2551

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

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/18/2013

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