Provider Demographics
NPI:1154185858
Name:VILLACRES, STEPHANY
Entity type:Individual
Prefix:
First Name:STEPHANY
Middle Name:
Last Name:VILLACRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1126
Mailing Address - Country:US
Mailing Address - Phone:347-263-9183
Mailing Address - Fax:
Practice Address - Street 1:177 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3733
Practice Address - Country:US
Practice Address - Phone:718-305-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR22841300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse