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NPI Code Detail

MEDICARE: MISS STEPHANIE NICOLE YORK CCC SLP

MEDICARE: MISS STEPHANIE NICOLE YORK CCC SLP
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
1235Z00000XSpeech-Language Pathologist022131NY

General Provider Information

NPI Number : 1922358480
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS STEPHANIE NICOLE YORK CCC SLP
Provider Business Mailing Address
First Line : 3993 DEMONT ROAD
Second Line :
City : SEAFORD
State : NY
Zip : 11783
Country : US
Telephone Number : 516-592-1611
Fax Number :
Provider Business Practice Location Address
First Line : 145 ROSEMARY ST STE K1
Second Line :
City : NEEDHAM HEIGHTS
State : MA
Zip : 02494-3259
Country : US
Telephone Number : 781-400-2482
Fax Number : 317-815-3861
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2012
Last Update Date : 03/17/2018

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