Provider Demographics
NPI:1588278733
Name:PISACANO, STEPHENIE LYNN (ND)
Entity type:Individual
Prefix:
First Name:STEPHENIE
Middle Name:LYNN
Last Name:PISACANO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16405 COUNTY ROAD 48
Mailing Address - Street 2:
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-1045
Mailing Address - Country:US
Mailing Address - Phone:631-655-8635
Mailing Address - Fax:
Practice Address - Street 1:16405 COUNTY ROAD 48
Practice Address - Street 2:
Practice Address - City:CUTCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11935-1045
Practice Address - Country:US
Practice Address - Phone:631-655-8635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ191845175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath