Provider Demographics
NPI:1386256451
Name:STUBBS, ALESSANDRA MARIE (LAC)
Entity type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:MARIE
Last Name:STUBBS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 VANDERBILT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1751
Mailing Address - Country:US
Mailing Address - Phone:516-476-0399
Mailing Address - Fax:
Practice Address - Street 1:65 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1751
Practice Address - Country:US
Practice Address - Phone:516-476-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0178481225700000X
NY06801171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty