Provider Demographics
NPI:1457423014
Name:MUNSON, STEPHEN WESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WESLEY
Last Name:MUNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CHEESE FACTORY RD
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-9303
Mailing Address - Country:US
Mailing Address - Phone:585-586-1600
Mailing Address - Fax:
Practice Address - Street 1:100 LINDEN OAKS
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2840
Practice Address - Country:US
Practice Address - Phone:585-586-1600
Practice Address - Fax:585-586-7951
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY1257622084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY102249EWOtherPREFERRED CARE
NY0789OtherBLUE SHIELD
7479049OtherAETNA
NYP01025762OtherBLUE CHOICE
NYB74951Medicare UPIN
NY17519BMedicare ID - Type Unspecified