Provider Demographics
NPI:1154871697
Name:STUDLEY, PATRICK DONALD (MSTOM)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:DONALD
Last Name:STUDLEY
Suffix:
Gender:M
Credentials:MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 BEEKMAN AVE
Mailing Address - Street 2:STORE C
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-2549
Mailing Address - Country:US
Mailing Address - Phone:914-909-6360
Mailing Address - Fax:
Practice Address - Street 1:95 BEEKMAN AVE
Practice Address - Street 2:STORE C
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-2549
Practice Address - Country:US
Practice Address - Phone:914-909-6360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003918171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist