Provider Demographics
NPI:1285997437
Name:ANDERSON, STEPHANIE S
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:S
Last Name:ANDERSON
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 1:480 CHARLES LN
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1408
Mailing Address - Country:US
Mailing Address - Phone:516-579-8620
Mailing Address - Fax:
Practice Address - Street 1:480 CHARLES LN
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1408
Practice Address - Country:US
Practice Address - Phone:516-579-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist