MEDICARE: STEPHANIE PERSAUD

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	106S00000X	Behavior Technician		NY

General Provider Information

NPI Number	:	1891640033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE PERSAUD

Provider Business Mailing Address
First Line	:	311 BRANCH AVE
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-6008
Country	:	US
Telephone Number	:	347-350-0168
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 WOODBURY RD
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-1007
Country	:	US
Telephone Number	:	516-364-5798
Fax Number	:

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

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “ STEPHANIE PERSAUD ” Practice Location

Language	Start Address	Practice Location

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