Provider Demographics
NPI:1588758403
Name:HIGBY, STEPHANIE K (PA)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:K
Last Name:HIGBY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-1227
Mailing Address - Country:US
Mailing Address - Phone:315-824-1250
Mailing Address - Fax:
Practice Address - Street 1:85 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-1227
Practice Address - Country:US
Practice Address - Phone:315-824-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011715-01363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028429205Medicaid
NYPA2257Medicare PIN