MEDICARE: MS. SONDRA ALEXIS STOUTE FNP-BC

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	363LF0000X	Family Nurse Practitioner	F344036	NY

General Provider Information

NPI Number	:	1962063149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SONDRA ALEXIS STOUTE FNP-BC

Provider Business Mailing Address
First Line	:	711 TROY SCHENECTADY RD STE 203
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2461
Country	:	US
Telephone Number	:	518-782-3700
Fax Number	:	518-782-3799

Provider Business Practice Location Address
First Line	:	101 JORDAN RD STE 200
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12180-8337
Country	:	US
Telephone Number	:	518-274-0476
Fax Number	:	518-274-0497

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

Provider Enumeration Date	:	06/27/2019
Last Update Date	:	06/27/2019

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