Provider Demographics
NPI:1285386276
Name:SMALL, STEPHANIE MARGARET (ANP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARGARET
Last Name:SMALL
Suffix:
Gender:
Credentials:ANP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARGARET
Other - Last Name:HASPETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1524 SWEET RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-3043
Mailing Address - Country:US
Mailing Address - Phone:716-704-5915
Mailing Address - Fax:
Practice Address - Street 1:220 RED TAIL RD STE 9
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1599
Practice Address - Country:US
Practice Address - Phone:716-503-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310692363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health